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THE /CLINIQUE. 

THE OFFICIAL ORGAN * 

OF THE 

ILLINOIS HOMEOPATHIC MEDICAL ASSOCIATION 

AND OF THE 

HOMEOPATHIC STATE MEDICAL SOCIETY 
OF WISCONSIN 



EDITOR 

II. V. IIALBERT, M. D. 

ASSISTANT EDITORS 

VANCE RAWSOX, M. D. GEORGE MARTIN McBEAN, M. D. 

BUSINESS MANAGER 

\VM. BYFORD TAYLOR. 



VOLUME XXVIII 



PUBLISHERS 

HALSEY BROS. CO. 
1907 



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INDEX TO VOLUME XXVIII. 



Abdominal organs, injuries of, Palmer 165 
Abdominal pain, significance of, Red- 
dish 280 

Accessory nasal sinuses, diseases in the, 

Swan 720 

Acute pancreatitis of the hemorrhagic 
type, simulating intestinal obstruc- 
tion ; operation, Shears 744 

Adams, G F., — Not an uncommon oc- 
currence 268 

Cactus grand iflorus. Adams 479 

Adolescent boy, the, Goodrick 391 

Adolescent girl, the, James 397 

Anesthesia, local, in nose and throat 

surgery, Street 198 

Anesthetic, selection of, Costain 160 

Anesthetization, some of the difficul- 
ties of, and why, Costain 612 

Appendicitis, necessity for early opera- 
tion in, Blouke 23 

Appendicitis, when to operate, Kahlke. 726 

Arsenicum case. Conger 419 

Arthritis, atrophic. Williams 487 

Au rand, S. H.. Homeopathy, under 
the subheads of faith, hope and char- 
ity _ 142 

Some of the things I tie to and 

why 332 

Aurutn, a practical study, Shedd 495 

Bailey, E. S., Internal remedies in gy- 
necology 647 

Baker, M. H., Development of man as 

animal 271 

Balcom, G. G., Acute catarrhal bron- 
chitis 134 

Barndt, M. A., Corneal in juries 281 

President's address Wis. State 

Homeo. Med. Society 427 

Beebe, E. W., Shall we call counsel ?.. 544 

Biggar, H. F 578 

Blackwood, A. L. , Clinical Cases 29 

Cholera morbus, its management 462 

Legislation as a prophylactic in 

tuberculosis 675 

Blouke, M. B., Necessity for early oper- 
ation in appendicitis 28 

Gastropexy 338 

Blunt, A. W., A metallic oircuit 413 

Bronchitis, Acute catarrhal, Balcom.. 134 

Brown. F. E. , Homeopathy 505 

Burke. J., Science and health 493 

Cabot, R. C, How far do homeopathic 
and other physicians agree and how 

far can thev agree ? 39 

Cactus grandiflorus. Adams 479 

Cancer of alimentary canal, two clini- 
cal cases, Vaughn 292 



Central 111. Homeo. Med. Ass'n 694 

Chicago Homeopathic Medical Society 

57, 117,289,814,571,704, 763 

Chislett, H. R., Surgical treatment, 

cirrhosis of liver, Case 25 

Treatment of chronic intestinal 

obstruction _. 596 

Cholera mprbus, its management, 

Blackwood 462 

Clinical cases, Blackwood 29 

Clinical cases. Proxmire 757 

Clinical society of Hahnemann College 118 

Cobb, J. P. , Infant feeding - 193 

Tuberculosis Tent Colony re- 
port 354 

Open air sanitarium work. 660 

Tuberculosis in infancy and 

childhood 740 

Collins, C. D., Eczema, a comparative 

study 219 

Colorado Homeo. Society, 120 

Commencement exercises, Hahnemann 

College 382 

Congenital abnormalities, Schlessel- 

man '. 189 

Conger, G. P., An arsenicum case 419 

Convergent strabismus, George 724 

Copper and its salts, Dale 465 

Corneal i n juries. Barndt, 231 

Costain, T. E , Selection of an anesthe- 
tic 160 

Some of the difficulties of anes- 
thetization, and why 612 

Dale, H. B., Artificial feeding of in- 
fants 1 257 

Copper and its salts 465 

Obituary ... 582 

Delamater, N. B., Homeopathic reme- 
dies in neurology 213 

Dienst, G. E., My reasons for not study- 
ing the materia medica 346 

Dodge, CCA plea for better sanita- 
tion as a prophylaxis in tuberculosis. 670 

Duodenum, ulcer of the, — acute per- 
foration, case, Kahlke . _ 421 

Ear, acute inflammation of the middle, 

Stearns.. 469 

Eastern Illinois homeo, Med. Ass'n. 814, 702 

Eczema, a comparative study, Collins. 219 
Electro- therapeutics in pelvic diseases 

of women. Koch 283 

Epilepsy, Pogue 530 

Exophthalmic goitre, case, Halbert ... 618 

EDITORIALS. 

A hopeful sign 33 

Our new year resolutions 84 



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IV 



Index. 



Court testimony 36 

Newspaper reform 37 

The milk supply Ill 

Immigration and health 114 

The iooal option question 115 

Traveling too fast 172 

Asylum clinics 173 

Worthy of consideration _ 175 

Medical education of the laity 179 

Homeopathy and the opsonin theory.. 238 

Jamestown and the Institute. . 235 

State charities demands 236 

Insurance examination fees 237 

The standing of Hahnemann College.. 296 
What's the matter with Illinois home- 
opaths? * 297 

Conflicting meetings $98 

Indiana's advocacy of sexual multila- 

tion 298 

Conspicuous vulgarity 300 

The State meetings 350 

Perverted news 851 

Brainstorms 852 

The church clinic v. Christian Science. 428 
Are nurses being too highly trained. . . 425 

The New York Medical law. 501 

Texas and the consumptives 502 

The Institute's suioidal policy 504 

School opens 564 

The use of nitrous oxide ^ 566 

Medical Colleges and the teaching of 

anesthesia 567 

Leukopenia in typhoid 568 

Isolation hospitals 569 

Shall we itemize bills ? 622 

Charity and the medical college dispen- 
sary 623 

The state society 625 

Do it yourself 626 

Support your journal 627 

Looking backward 759 

Fellows, C. G., Some recent experiences 
in apparently hopeless cases 549 

French, M. R., Homeopathic attenua- 
tions 21 

Fish, H. M., Remarks on certain symp- 
toms of nasal sinus disease whioh 
may simulate intracranial lesions ... 308 

FitzPatrick, G., albuminuria in preg- 
nancy 88 

Forebeok, F. A., .Movable kidney; a 
surgical review 49 

Gall-bladder and bile ducts, surgery of, 

Kahlke 11 

Gall bladder surgery, McBuroey 472 

Gastric diseases, Pulsatilla in, Halbert. 264 

Gastropexy, Blouke 388 

George, E. J., Removal of a piece of 
iron from an eye followed later by 

gonorrheal iritis 196 

Convergent strabismus 724 

Goodriok, M. H., The adolescent boy.. 392 
Gynecology, international remedies in, 

Bailey 647 

Gynecological massage, Richmond 736 



Hahnemann Hospital, large gift to 61 

Hahnemann Medical College, Com- 
mencement exercises 382 

Opening Exercises 632 

Halbert, H. V., Facts relative to tuber- 
culosis 216 

Pulsatilla in gastric diseases . . . 264 

A clinical report 617 

Rheumatic fever, its etiology 

and treatment 753 

Hanks, M. E., President's address, 111. 

State Homeo. Med. Ass'n, 321 

Harkness, C. A., Three cases of embo- 
lus of central artery of the retina . . 223 

Hemorrhoids, Pratt 713 

Hewitt, M. R, Prescribing by aid of 

the repertory ._ 600 

Hinsdale, W. B., Medical lessons from 

life 1 

Homeopathic and other physicians, 
how far do, and can they agree, 

Cabot 39 

Homeopathic attenuations, French ... 21 

Homeopathic Index Medicus 

404, 508, 572, 630, 705 

Homeopathy, Aurand 148 

Homeopathy, Brown 505 

Hurd, A., Light as an adjuvant in the 

treatment of tuberculosis 150 

Hyoscine in obstetric anesthesia, Skin- 
ner, 551 

Illinois State Homeopathic Medical So- 
ciety 55, 238 

Secretary's address, Hasel tine.. 810 

President's address, Hanks 321 

Tuberculosis Tent Colony re- 
port, Cobb 854, 377 

Index medicus, homeopathic 

434, 508, 572, 630, 705 

Infants, artificial feeding of, Dale 257 

Infant feeding, Cobb 198 

Insane, modern methods in care of the, 

Whitman 455 

Intestinal obstruction, diagnostic symp- 
toms of acute, Rawson 586 

Intestinal obstruction, treatment of 

acute, Shears 589 

Intestinal obstruction, treatment of 

chronic, Chislett 596 

Iritis, gonorrheal, following removal of 
piece of iron from eye 196 

James, K. E., Pain _ 207 

The adolescent girl 897 

Kahlke, C. E., Surgery of the gall- blad- 
der and bile ducts 11 

Appendicitis, when to operate.. 726 

Clinical cases with notes 420 

Kent, J. T., Cases cured with natrum 

sulphuricum 418 

Kentucky State Homeo. Med. Society. 313 
Kidney, movable, surgical review, 

Forsbeck 49 

Koch, M., Electro therapeutics in pel- 
vic diseases of women 283 



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Index. 



Korndoerfer, A. f Therapeutics: The 
acme of medical art, the bane of sec- 
tarianism 556 

Leach, G. A., Important remedies not 

widely used 842 

Lenfestey, J. A., Infantile syphilis 655 

Leonard," W. H., Potentized v. crude 

drug 182 

Liver, surgical treatment, cirrhosis of, 

Chislett 25 

Lycopus virginicus 559 

Lympbatious, status, Schneider 491 

Maas, E: C. Uterine displacements 200 

Martin, C. V. diagnosis of tuberculous 

meningitis 285 

Materia medica from standpoint of gen- 
eral practitioner, Richardson 130 

McBurney, B. A., Gallbladder surgery 472 

Medical lessons from life, Hinsdale 1 

Met calf , F. . cases of paralysis 605 

Minnesota State Homeo. Institute 365 

Minnin light as a mitigator of pain, 

Vance 540 

Missouri Institute of Homeopathy 315 

Mitchell, C, Some clinical memor- 
anda 104 

A case of chronic interstitial 

nephritis 608 

Urinalysis negative 711 

Moser, G. H., Personal experiences in 

obstetrics 226 

Moynihan, a day with, at Leads, 
Shears 108 

Natrum sulphuricum, cases cured with, 

Kent 418 

Nebraska Homeo. State Aes'n 314, 376 

Nephritis, case of chronic interstitial, 

Mitchell 608 

Neurasthenia, Runnels 534 

Neurology, homeopathic remedies in, 

Delamater 213 

Northwestern Homeopathic Medical 

Society 701 

Obstetric anesthesia, hyosoine in, 

Skinner 551 

Obstetrical practice, sepsis vs. asepsis 

in, Webb 75 

Obstetrics, personal experiences in, 

Moser 226 

Ohio Homeopathic State Society 381 

Open air sanitarium work, Cobb 660 

Opsonogens, treatment of skin and in- 
fectious diseases by Stevens 519 

Pain, James 207 

Palmer, O. A., Injuries of the abdom- 
inal organs 165 

Paralysis, cases of. Metcalf 605 

Physician, the,— and then nome, Wie- 

land 209 

Pogue, M. E., Epilepsy 520 

Postdiphtheritic brain embolism 616 

Postpartum hemorrhage, Starr 80 



Potentized vs. crude drug, Leonard... KJ2 

Pratt, E. H., Psychological surgery... 154 

Hemorrhoids 713 

Pregnancy, albuminuria in, Fitz Pat- 
rick 88 

Pregnancy, diagnosis of, Storey 83 

Proxmire, T. S., Clinical cases 757 

Psychological surgeon . Pratt 1 54 

Puerperal fever, Ripley 65 

Ralph, Rev. E. A., What boys and girls 
should be taught 407 

Rawson. V., Diagnostic symptoms of 
acute intestinal obst ruction 586 

Reddish, A. W., Significance of abdom- 
inal pain 280 

Retina, embolus of central artery of, 
three cases, Harkness 223 

Retrodisplacenients, treatment of, 
Strawn 9 

Rheumatic fever, its etiology and treat- 
ment, Halbert 753 

Richardson, O. K., Materia medica 
from standpoint of general practi- 
tioner 130 

Richmond, Y. G., Gynecological mas- 
sage 736 

Ripley, G. H., Puerperal fever 65 

Somnoform as an anesthetic . . . '583 

Roberts. W. B., Sarcoma of bone 202 

Rock River Institute Meeting 

59, 241, 312, 628 

Runnels, . D. S. , Neurasthenia 534 

Sarcoma of bone, Roberts 202 

Sch lease 1 man, J. T., Congenital abnor- 
malities 139 

Schneider, A. B., Status lymphaticus . 491 
Shears, G. F., A day with Moynihan at 

Leeds 108 

Acute pancreatitis of the hem- 
orrhagic type, simulating intestinal 

obstruction ; operation 744 

Treatment of acute intestinal 



obstruction 589 

- Surgical Notes 679 



Shedd, P. W., Aurum, a practical 

study 495 

Skinner, H. O., Hyoscine in obstetric 

anesthesia 551 

Smith, A. E., By what marks shall we 

know them? 288 

The necessity for and success of 

tent colony work 664 

Somnoform as an anesthetic, Ripley . .' 583 

Special clinical course 253 

Starr. W.. Post part urn hemorrhage... 80 
Stearns, W. M., Practical hints on 

acute inflammation of the middle ear 469 
Stevens. R. H., Eight months' exper 

ience in the treatment of some skin 

and infectious diseases by opsonogens 519 

Stomach cases. McBurney 729 

Stomach, ulcer of the, case, Kahlke, .. 420 

Stone, S. R . Cases from practice 562 

Storey, W. O., Diagnosis of pregnancy. 83 



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vi • Indkx. 

Strawn, Julia C. Local and adjuvant Tuberculous meningitis, diagnosis of, 

treatment of retro displacements __ 9 Martin 285 

Street, R. H., Local anesthesia in nose Tuberculosis, legislation as a prophy- 

and throat surgery 198 lactic in, Blackwood 675 

Surgical Notes, Shears 679 Tuberculosis, light as adjuvant in 

Swan, C. J., Disease in the accewsory treatment of , Hurd 150 

nasal sinuses 720 Urinalysis negative, Mitchell _ 711 

Syphilis, infantile. Lenf estey 655 Uterine displacements, Maas 200 

Tent colony work, the necessity for Vance. J. W., Minnin light as a miti- 

success of , Smith 6P4 gator of pain 540 

Therapeutics, rational, Walters 481 Vaughn, E. E., cancer of alimentary 

Therapeutics ; the acme of medical art, canal, two cases 292 

the bane of sectarianism, Korndoer- Walters. J. A., rational therapeutics.. 481 

fer 555 Webb. W. B., sepsis vs. asepsis in gen- 
Tuberculosis Tent Colony 61 eral obstetrical practice _ 75 

Tuberculosis Tent Colony report, Cobb. 354 Whitman. F. G., Modern methods in 

Tuberculosis, a plea for better sanita- care of the insane 455 

tionasa prophylaxis in, Dodge 670 Wieland, F., The physician and then 

Tuberculosis in infancy and childhood, some 209 

Cobb 740 Williams. E. C.. atrophic arthritis 487 

Tuberculosis, facts relative to, Halbert. 216 Wisconsin State Society 295, 375, 482 



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THE CLINIQUE. 



VOL. XXVIII. JANUARY, 1907. NO. 1 



®rignral ^rtxctes. 



MEDICAL LESSONS FROM LIFE. 

W. B. HINSDALE, M. D., ANN ARBOR, MICH. 

The great achievement claimed for present-day medicine is that dis- 
eases of the infectious class particularly, are coming more and more 
under control. The argument is about as follows: Sanitary improve- 
ments will hinder the spread of disease; this is a time of advanced ideas 
in regard to sanitary matters; consequently disease must be on the de- 
crease. 

Statistics of Infectious Diseases. — A pitiable tale is told by Manager 
of United Hebrew Charities, Frankel, of New York. From the census 
reports he shows that the death rate per 100,000 for the most common 
diseases increased during the decade from 1890 to 1900. In only three 
diseases out of a list of fourteen was there a decrease, viz. : cholera in- 
fantum from 3,209 to 2,461; diphtheria from 3,306 to 1,586; consump- 
tion from 12,146 to 10,688. The decrease in cholera infantum, which 
disease is a food-poisoning, is due, if not to fortuity, to improvement in 
milk supplies. The decrease in diphtheria the doctor will certainly 
attribute to antitoxine, which is not particularly a sanitary method of 
treatment. Had he consulted the rate for the Britisli Islands for the 
same time, he would have found an increase in diphtheria without any 
explanation. 

The decrease for consumption, if not also accidental, is probably due, 
somewhat to sanitary precautions. The entire country, at this time, 
is aroused in regard to consumption. It is the fashion of the laity, as 
well as among the profession, to give, just now, especial attention 
to the prevention of tuberculosis, of which consumption is one 
form, and to the care of those infected. Because the people are aroused 
in regard to cousumption, it does not particularly indicate that they 



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2 THE CLINIQUE. 

are especially careful about other dangerous communicable maladies. 
We are not aware that special attention is given by the public to pre- 
vention of gonorrhea, syphilis, scarlet fever, pneumonia, typhoid 
fever, etc. Aside from the fact that a good many families boil their 
drinking water, there is no particular evidence of apprehension on the 
part of the communities about any of these and other serious ailments. 
Probably the explanation for this will be the common one: " The peo- 
ple are not yet educated up to that point. n 

Tuberculosis is not the only pulmonary plague. The death rate for 
pneumonia is about the same as that for consumption. In some local- 
ities pneumonia, as a cause of death, leads consumption. The percent- 
age of decrease in consumption for the period referred to was about 
twelve; the percentage of increase for pneumonia, for the same period, 
was eleven. The decrease in the one pulmonary disease is off-set by 
the increase in the other. Is it not strange, if the decrease in consump- 
tion is so much due to public sentiment being excited to the precaution- 
ary point, that the public have not been aroused, also, in regard to an- 
other equally grave and severely rapid lung trouble which every year is 
claiming an increase in its percentage of victims ? 

Nature of Epidemics. — It is not the object of this discussion to min- 
imize the importance of all or any prophylactic measures that science, 
experience or accident have discovered or may discover. On the con- 
trary, the highest valuation is placed upon them. Sanitary science has 
kept back many pestilential diseases from our shores and seemed to 
bring under pretty complete control some others that were one time 
formidable. An example of the former is the prevention of Asiatic 
cholera, of the latter, erysipelas. 

It cannot be successfully maintained, however, that all the changes 
in the character of diseases, the ebbs and flows of disease tides, are due 
to, or are controlable by, human efforts, be they ever so scientifically 
deduced and skillfully applied. Long periods of time have elapsed 
when certain diseases have seemed almost suppressed, as we would say, 
naturally, owing to conditions that we do not understand. These same 
diseases break forth again with violence and sweep over large portions 
of the world either destroying life immediately or impairing the health 
of thousands, predisposing them to other maladies, again to become 
comparatively quiescent. The history of epidemics clearly justifies the 
statement that some waves of activity have lasted several centuries and 
then were followed by equally long periods of lessened intensity. At 
other times the periods have been much shorter, lasting only a few 
years or months. I wish to fortify this statement by a reference to an 



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THE CLINIQUE. 3 

English author, F. W. Headley (Problems of Evolution) who, after 
discussing the ravages of tubercular diseases in England, shows by 
references to the Register-General's reports that diphtheria has much 
increased of late years and that, influenza, long almost forgotten, sud- 
denly in 1890, swooped down upon Europe. He iurther adds: "To 
the destructive pests that have improved their unenviable position, we 
have to add pneumonia." The United States census reports show that 
so childish a disease as measles is more fatal than formerly. We all 
know that since the Spanish war, small-pox, one of the old-time pesti- 
lences has been more prevalent than for many years before. Even the 
itch parasite, that once haunted the homes of kings, sank so far into 
disgrace that it hardly dared to bridge over a long period of quietude 
in low hovels, has now hundreds of hosts among the students of Mich- 
igan University. It has been noted for some years that scabies is find- 
ing its way back into society. 

If a lull in an epidemic appears to be coincident without our efforts 
to stamp it out, we may be deceived and attribute too much to science 
and too little to unusually inscrutable influences. 

In spite of all that is being done to purify water supplies and correct 
other means of conveyance of typhoid infection, in 1900 there were 
3,405 deaths from this disease per 100,000 against 3,216 for 1890, an 
increase of 189. It is my personal conviction, based upon observation 
and reports in medical journals, that typhoid fever has been more preva- 
lent for the past eighteen months than it was when the statistics em- 
bodied in the last census reports were gathered. 

Preservation of Children, especially Defectives. — While, during the 
statistical period referred to x there was an increase in diseases of the 
stomach of 338 per 100,000 there was a decrease in cholera infantum of 
808. In this connection it must be said that probably the greatest 
achievement of recent medical methods has been the amelioration of 
diseases incident to the first five years of life. This ha$ been brought 
about by a better sanitary control of the food supply and a milder en- 
vironment of which the doctor and trained nurse, with their new dis- 
coveries, are a part. Charity wise and unwise has been very active in 
assisting to save the lives of those in the tender years. With some it 
may be a question whether science and charity, by indiscriminately 
softening the environment of the degraded, weakly and unproductive, 
no matter what the age, is bestowing a blessing upon civilization or 
not. The question is raised in this form by a biologist and a sociolo- 
gist: " By preserving the weak ones, we allow them to hand down to 
the next generation their weak constitutions and so the race will aver- 



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4 THE CLINIQUE. 

age less robust than it would be if the weak ones had been allowed to 
succumb and so never have any offspring. Similarly the physician saves 
from death many weaklings whose children bring down the average of 
physical efficiency in the next generation." (Metcalf, Organic Evolu- 
tion, 170). 

Statistics of Constitutional Diseases — We boast that during the past 
half-century four years have been added to the average duration of life 
in this country. It has been done largely by saving the lives of infant 
weaklings. When we come to consider the diseases of advanced years, 
there is no consolation for us because constitutional diseases, almost in- 
variably, of that period of life are not yielding to the microbe-killer and 
the physiological chemist's advice, if he has any. 

The following expression is from the twelfth census report of the 
United States (Vol. Ill, Vital Statistics, part I) "An increase in the 
relative mortality from diseases most frequent in adult life and advanced 
age, and a decided decrease in mortality from diseases incident to in- 
fancy and youth." The period of productiveness of the energetic 
American is not increased; if anything it is shortened by the constitu- 
tional breakdowns that he cultivates with restless activity. 

In confirmation of this, let the following facts be put in evidence: 

Cancer. — The increase in cancer is alarming, having arisen from 
2,303 per 100,000 to 2,837, an increase of 634. A few remarks about 
cancer may be pertinent. Probably the testimony of the best living 
pathologists is decidedly against attributing it to a microbic origin. 
However, there are those who believe it is in some way communicable, 
but those who propose this theory do so only tentatively. Whatever 
be the predisposing and determining causes, statistics indicate that- 
cancer is rapidly on the increase all over the civilized world. The fol- 
lowing facts are interesting and will help to impress the mind that there 
is at least one plague of the most fatal and loathsome sort that neither 
medical science, surgical art, prophylaxis or hygiene have deterred 
from destroying a greater number of victims every year for at least fifty 
years. 

(a) Of all neoplasms as cause of death over eighty per cent, are 
cancers. 

(b) Of all cancers over fifty per cent, are in the digestive tract. 

(c) Cancers of the digestive tract have increased out of proportion to 
all others. 

(d) Cancer is rapidly on the increase now, especially cancers of the 
digestive tract. 

(e) Cancer is being found more and more between puberty and thirty; 



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THE CLINIQVE. 5 

whereas it was formerly supposed to be almost entirely a disease of ad- 
vanced years, forty-five and over. From the city of Stuttgart, where 
accurate records have been kept in regard to cancer for a long time, the 
following report is made: 1. Increase of cancer in general. 2. In- 
crease of cancer in proportion to other diseases. 3. Increase of cancer 
in the digestive tract compared with other organs. 4. The general in- 
crease in cancer is made up by the increase in that of the alimentary 
tract. 5. The increase was the greatest among males, relatively, 
especially so far as sarcoma was concerned. There were 1,005 deaths 
from cancer in the alimentary tract and 382 from cancer in other or- 
gans — an increase is shown of .27 % in other organs to 449.8 % in the 
alimentary tract. 

I appreciate that Stuttgart is not an American city, but what is true 
of that city, is true of the civilized world. 

Circulatory System, Etc. — Diseases of the circulatory system, by 
which is meant organic defects in the heart, arteries and veins, are be- 
coming more deadly both in this country and in England. During 
1900, 1,347 more deaths from heart disease per 100,000 occurred than 
in 1890. There were as many again cases of angina pectoris in 1900 
as there were ten years before. The number of deaths from diabetes 
also doubled. Bright's disease and other diseases of the urinary organs 
annually increases by a large percentage. Accidents, casualties, in-> 
juries and suicide, which of course are not diseases in the ordinary 
sense, are increasing out of proportion to the population. While con- 
vulsions, which is almost entirely a child's disease, if we may call it a 
disease entity, decreases, disorders of the nervous system, as a cause of 
of death, increased by ten per cent. 

Mortgages. — There is a cause of disease that we do not read about in 
books or hear discussed in societies, and that is mortgages. It may 
not be proper to name a condition from its predisposing cause, but an 
extensive observation among both country people and town dwellers of 
moderate earning capacity has convinced me that the struggle for the 
homestead and the farm, which is a kind of struggle for existence in a 
larger sense, are frequent causes of bodily and mental wreckage. In 
close times, like specters, they haunt the homes, cripple the strong men 
of the houses and enervate the willing wives and mothers until break- 
downs from worry and over-work incapacitate one or both of them and 
send large contributions to the insane asylums. I have seen it stated 
that in the agricultural states, unless it be farmers, there are more farm 
wives in the asylums than people of any other class. No one, not even 
the minister, knows so much of this side of social life as the physician; 



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6 THE CLINIQUE. 

a condition for which his pill bags yield no balm. The scientist in his 
laboratory searching for germs and germicides knows little, unless it be 
his own, of the home-debt as a precursor to scores of diseases, microbic 
and others. 

Lack of Confidence in Medicines. — So far, I have endeavored to pre- 
sent a few of the problems in the management of the epidemic and de- 
genet ative diseases. What can be done to reduce the death-rates, if 
anything? During the past twenty years, there has been a great lack 
of confidence in medicines, excepting a few pain-easing sedatives. 
Those who are skeptical in their therapeutics say when a cure follows 
a prescription that it is " luck" or mere coincidence, that diseases tend 
to self-limitation and that recoveries are spontaneous. If a single case 
of pneumonia, for example, tends towards recovery, will not an epi- 
demic which is only an aggregation of cases also tend to exhaust itself ? 
On the other hand, if an epidemic becomes more prevalent, if it re-at- 
t^cks its former victims, or becomes more malignant in character in 
spite of preventive measures, we blame our boards of health and every- 
body else for letting so uncontrolable a force get the start of them. 
Efforts for contributing the human increment towards controling dis- 
eases should not be slackened, even if laws governing their periodicity, 
intensity or epidemic tendencies be not wholly discoverable. When 
hygienic improvements, serum therapy, electricity, tubbing, dietetics, 
and what not, have failed to accomplish all that their several promul- 
gators have promised for them, taking advantage of all there is good 
in them, is it not worth while to turn again to internal medication as a 
means of cut ing a part of what cannot be prevented ? 

Of all branches of medicine, therapeutics has been the most neglect- 
ed. It can truthfully be said it has been absolutely abandoned by a 
great many, if any credence is to be placed upon their utterances. 

Human nature is liable to magnify the promises of new things, and 
to underestimate the value of the old. Is it not possible that before in- 
ternal medicine fell into disrepute and all possible conquest over dis- 
eases was staked upon preventive and hygienic measures that a greater 
percentage of those who actually became ill were cured ? Of course 
there are no statistics bearing upon this point. But it is a fair infer- 
ence from the death-rates that the number of cures has not been in- 
creasing. 

Surgery. — Of course, surgery has saved or prolonged a large number 
of lives that, without it, or under the old imperfect methods, would 
have been lost. Surgery is a mechanical art. It deals with the mic- 
roscopic and grossly pathological. Its methods apply to the visible, 



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THE CLINIQUE. 7 

tangible, circumscribed, locally determinable mass. The surgeon sees 
or feels the adjustments of a dislocation or the separation of an adventi- 
tious growth. Curable surgical diseases are local and therefore definite. 
Not so with disease poisons and tissue degenerations. The changes in 
the vital, living cells are largely indeterminate and more or less dis- 
seminated. No mechanics will ever restore them. They must be 
counteracted by imponderable agents empowered with the same subtle 
permeability and absorbability as the poisons themselves. Since dis- 
ease processes are unseen and invisible, it is easier to turn to lines of 
practice that deal with them. Surgery has been and now is a very in- 
viting field for the ambitious young doctor. Its underlying anatomical 
principals are comparatively easily learned. Success in it depends 
largely upon manual dexterity; the results are more spectacular and 
the remuneration is in appreciable amounts. However, surgery seems 
to be reaching its limitations. Its conquests for the next twenty years 
cannot be as great as for the past same number of years. It has pretty 
well covered the human anatomy. There yet only remain for it the 
thorax and a few by-corners of the rest of the body. 

Thus surgery has developed at the expense of drug therapy. Since 
the physician cannot see his medicines act or may not comprehend 
their modes, he is often disposed to give up their uses and resort to adju- 
vants and the arts of nursing and hygiene, depending upon them too con- 
fidently or expectantly, as we sometimes say. No physician is doing 
his full duty to his client who neglects all the collateral arts of medi- 
cine, neither is he doing his duty if he fail to intelligently employ the 
wonderful powers that reside in drugs. If he is ignorant of the 
latter, he has neglected a part of his medical education. Had therapeu- 
tic experimentation and research kept pace with the other subjects that 
are comprised in the term medicine, we would today be better prepared 
to combat the disease that we are failing to prevent. 

The Necessity. — So far as the zymotic and constitutional diseases are 
concerned, what the coming doctor must resolutely resolve to do, after 
preventive measures have been exhausted, is to discover cures. A 
rational therapy that relies upon the energy that nature has stored up 
in what we call drugs to correct the morbid manifestations of vital 
phenomena in the living cell, will yet be found of greater efficacy than 
we seem to have had faith, for the past few years, to believe. I make 
this remark in spite of the statement of one noted specialist who says it 
gives him pain to hear the announcement of a new drug or remedy. 
Or another who affirms that there is no cure or relief for pneumonia. 
He would advise, after announcing his diagnosis, standing by and wait- 



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8 THE CLINIQUE. 

ing for spontaneous resolution or dissolution. Like a drowning man 
in the water, the victim must sink or swim. There is no rope, no 
plank, nothing to throw out to him to assist nature in trying to float 
him to shore. The more there is done to try to save him, the more 
will be added to his embarrassment. Such is the treatment, not of 
pneumonia, but of the pneumonic at present, the disease that is out- 
rivaling consumption. So one might go on showing the utter con- 
tempt that the up-to-date doctor seems to have for his medicines. 
However, during the years when medicines were more in vogue, even 
though prophylactics were looked after less and the doses were largely 
allopathic; it seems from Doctor Frankel's collection of statistics, that 
fewer people died, on the average, of the fevers than there do now. 

Attitude of Homeopathy. — So far as surrendering or neglecting their 
therapeutics is concerned, the homeopathic profession is not so seriously 
at fault as the old school wing of the profession. We have been pretty 
consistent in our medication, and we are always ready to compare as to 
results. I believe there is not one of us so faint-hearted as, for exam- 
ple, to have given up to pneumonia, typhoid fever, scarlet fever, men- 
ingitis, rheumatism or bronchitis by simply making a diagnosis and 
calling daily to see if the nurse is putting on the ice bags. There is no 
doubt, however, that we have been less ambitious than formerly to de- 
velop our therapy. We, as well as the rest, have qualified in surgery, 
and employed all the means of extraneous amelioration. While we 
have been doing this, which of course was very necessary, we have 
neglected somewhat our materia medica, that differentiating distinction 
of a homeopathic physician. It may, in the long run, prove that it was 
wise to have taken this intermission that we might keep abreast of the 
times in the newer acquisitions of medical science. Now let our doctor 
hold all he has learned about the new and useful side-arts and apply 
himself in catching up in that domain in which he must also either 
distinguish himself or lag behind. 

All medical men do not agree that medication must play an insignif- 
icant or a minor part hereafter. A reaction is setting in, except per- 
haps among certain extremists, towards the study and skillful applica- 
tion of internal remedies. A therapeutic revival is imminent. Now let 
me come to the point that I had in mind when I began with this dis- 
cursory review. There are clearly two practical things to do. One is 
to give greater head to our remedies that experience has demonstrated 
to be efficacious and curative, to learn how to use them with skillful dis- 
crimination and differentiation. Another one is for those of us who 
are able to try to amplify and better our system. These, I am aware, 



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THE CLINIQUE. g 

are trite sayings, but on their observance depends our future as a 
school of medicine who prescribe remedies according to what we be- 
lieve to be a scientific method. 

No one of intelligence denies but that as many cures result from 
homeopathic medication as from any. The great Osier committed 
himself to this conviction years ago. That being so, we certainly have 
as distinctive rights before the medical world and the public as any 
one. We believe, ourselves, that more cures result from our prescrib- 
ing, and, knowing so, it is within our power, with a little more atten- 
tion to pure therapeutics to lend somewhat towards a better showing in 
the census reports of the future. 



LOCAL AND ADJUVANT TREATMENT OF RETRODISPLACE- 

MENTS. 

JULIA C. STRAWN, M. D., CHICAGO. 

This subject of retrodisplacements has been so thoroughly handled 
in its etiological factors; and so exhaustively treated surgically I feel 
we must have the local and adjuvant treatments given their share of 
consideration. 

Many of you know perhaps better than I the pathology usually con- 
sequent upon these conditions of retrodisplacement. 

First, the increased size of the uterus frequently found due to em- 
barrassed circulation and lack of good drainage at the menstral period, 
hence we often find metritis and a chronic inflammation of the paren- 
chyma and endometrium. The constant pressure of the fundus push- 
ing down the Douglas pouch on the pelvic floor, causes it to adhere to 
the anterior surface of the rectum. 

The external os becomes patulous and often inflamed. If children 
have been borne the cervix is flattened and lacerated. The ligaments 
are stretched, ovaries frequently misplaced and inflamed as are also the 
Fallopian tubes, and the ureters may be compressed. 

Naturally and fortunately we do not find these conditions always pre- 
sent and seldom do we see all in one patient for it is unusual to find re- 
trodisplacements with no pelvic symptoms whatever. In making 
physical examinations if I find such a misplacement with no definite 
symptoms I never tell the patient of its existence for some one has 
said " a woman has two brains one in her head and one in her pel- 
vis" and if she is nervous and knows of the pelvic condition will 



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io THE CLINIQUE. 

think that every ache or pain attributable to that. However when 
I am confident the patient's physical and mental welfare depends upon 
the proper care and treatment of this pathological state I first try 
to remove the cause by reducing the inflammation not only of the 
uterus but the adnexa and pelvis, and reposit the offending organ 
if possible. If not possible I use some medication in the way of ich- 
thyol, iodine, hydrastis, calendula, or magnesia sulphate. With all 
the above I use a generous quantity of glycerine or boro-glyceride for 
its hygroscopic effect on the inflammatory bands and tissues, using either 
strips of gauze, cotton and wool, plain cotton, brace tampons depending 
upon the nature of the case as to which medication or mode of appli- 
cation of same. If a patient is confined to bed with pronounced cellu- 
litis I inject an ounce or two of above solution into vagina and enough 
cotton to hold in place. 

As soon as possible I reposit the uterus by any of the following meth- 
ods. Digital, bimanual, retro-abdominal, or by use of a repositor and 
sounds. I then place a brace tampon made entirely of tightly rolled 
cotton 2 or 2 % inches long and about ^ inch in diameter with string 
tied around the center. This is inserted lengthwise in the vagina up to 
the cul-de-sac. Then I turn it crosswise behind the fundus having 
previously medicated or lubricated in some way — this keeps the repos- 
ited organ in place and does not irritate either the fundus or a prolapsed 
sensitive ovary. I also insist on the patient sleeping on the side or 
stomach and assuming the knee-chest position two or three times daily, 
from three to thirty minutes if possible. If she cannot come to the 
office oftener for treatment she is instructed to dilate the vagina while 
in the knee-chest position. The inflation of vagina with air will often 
reposit a movable retroverted uterus. 

Massage is also a most valuable adjuvant if properly given thus stim- 
ulating the circulation and strengthening the tissues and ligaments. I 
believe one authority states there are 45 different mechanical de- 
vices for use in retrodisplacements, some of which are good and many 
of which I have found from clinical and private experience useless. 
The pessary is most valuable if no inflammation exists, but must be 
carefully and perfectly fitted and watched daily for a short time and ex- 
amined often (at least once a month ) thereafter, to prevent producing 
more harm than good. Those we have found most useful are the 
Smith-Hodge, Albert Smith, Thomas, Mundi and Hodge. 

Electricity. — If adhesions have formed I have found the use of the 
galvanic current will help absorb the inflammatory bands. If the dis- 
placements come from a relaxation of the tissues and ligaments the in- 



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THE CLINIQUE. ir 

teirupted Faradic current is of great value in its stimulating and re- 
generative effect. 

The hygiene and care of the general health must be closely watched. 
The patient should be taught how to breathe to lift the abdominal walls, 
how to stand and dress properly. High heeled shoes and tight con- 
stricting clothing should be abandoned. Cold salt baths, spray, and 
spatting the abdomen to tone up the relaxed muscles and ligaments 
with general rules for good diet and proper attention to the elimination 
are essential. These with the indicated remedy will in very many cases 
cure entirely. 

To sum up: 

1. Prophylactic — after childbirth prevention of too tight abdominal 
binder with pressure over uterus — keeping patient from lying constantly 
on back. 

2. Reduction of inflammation. 

3. Repositing uterus. 

4. Mechanical support — pessaries, tampons, packing, braces. 

5. Massage. 

6. Electricity. 

7. Baths and sprays. 

8. Respiratory gymnastics. 

9. Hygiene — dress, exercise, nourishment, elimination. 
10. Last but not least, posture, internal remedy. 



SURGERY OF THE GALL-BLADDER AND BILE DUCTS. 

CHARLES E. KAH^KE, M. D., CHICAGO. 

When we stop to consider the difference in the mortality attending 
early and late operations on the diseased gall-bladder and bile ducts, 
we are impressed at once with the significance of the results. 

Kehr, Mayo, and others, place the mortality attending simple chol- 
ecystostomy without inflammatory complications at less than one per 
cent; in cases with surrounding adhesions, stone in the cystic duct, 
empyema of the gall-bladder, etc., at three to five per cent, while cases 
of stone in the common duct give us a mortality of over eleven per 
cent. Carcinoma gives us a mortality of 22 per cent. 

If, with these figures, we reason that ten per cent of all adults have 
gall-stones, that of these five per cent produce enough disturbance to 



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12 THE CLINIQUE. 

call for surgical attention, and that of these active cases four (Mayo) 
to fourteen per cent (Schroder) develop carcinoma, our duty is clear — 
early diagnosis and early operation to save many a life and much suffer- 
ing. 

In this respect the gall-bladder is passing through the same history 
traversed by the appendix a few years ago. 

If the early operation will give a mortality of less than one-half of one per 
cent. — and a later one of over eleven per cent. — why should we wait? If, 
again, you reason that comparatively few stones pass through the com- 
mon duct, but remain lodged there as a new and more formidable men- 
ace, why should you wait and hope that each attack will be the last ? 
It is true that many cases with recurring attacks of appendicitis have 
apparently recovered spontaneously and remained so for years, but who 
would say the cases are cured, or the reason that because of these ex- 
ceptional cases all others will be like them? In this connection, I re- 
call a case of abscess of the liver following repeated attacks of cholecys- 
titis — who for six weeks refused operation on the ground that her 
mother, who was caring for her at the time, had had frequent attacks of 
" biliary colic with jaundice " for twenty years and was still hale and 
hearty. I operated successfully later, removing a pint of pus and seven 
gall-stones through an opening in the dorsum of the liver. 

As to the objection that, if removed, they will form again, experience 
disproves the idea. In over two thousand cases by six different opera- 
tors not one single case of recurrence could be found. (Murphy). If 
stone was found later it proved to be one overlooked in the primary 
operation. It is especially easy to overlook a stone lodged in the com- 
mon duct where it favors stagnation of bile and increased infection — 
two conditions which so often lead to further stone formation either in 
the hepatic ducts or the gall bladder, to say nothing of the possibility 
of a suppurative cholangitis with its direful results. 

It remains for us to make the diagnosis, and make it at a time 
when the mortality should be low. It is hardly worth your while to 
enter into the symptomatology of the classical cases that every one will 
recognize at a glance, but it would pay rather to take up the symptoms 
so often misinterpreted. " stomach cramps," " gastralgia," " indiges- 
tion," " bilious vomiting," " hepatic fever," etc., often stand unchal- 
lenged as diagnosis because there is no jaundice and never has been, 
because there are no clay-colored stools, no tumor of the gall-bladder, 
because the patient has never passed gall-stones by the bowels, and, 
furthermore, because there often is an associated indigestion or actual 
pathology of the stomach obscuring the primary cause. As the symp- 



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THE CUNIQUE. 13 

toms are very apt to come on after a full meal, and as the patient is very 
apt to feel relief after emptying the stomach, it is only natural to refer 
the symptoms to these organs. Or the case may be one of dilatation of 
the stomach and the real cause of the pyloric obstruction either remain 
unrecognized, or, because of the dilatation, pain and indefinite tumor 
mass, wrongly called pyloric cancer. Ulcer of the stomach is another 
very common diagnosis, but unless actually present as an additional 
finding should not be confounded with gall-bladder disease. And so 
we might go on mentioning one diseased condition after another, often 
correctly diagnosed in itself, but considered primary instead of second- 
ary. Instead of following this irregular plan, however, let us look at 
the pathology of the gall-bladder and biliary passages and think of the 
possible symptoms to which it may give rise. 

I will not consider the normal anatomy of the gall-bladder and the 
bile ducts except in so far as the lymphatic and nerve supply is con- 
cerned. 

The gall-bladder has no lymph glands and but very few lymph chan- 
nels. There is one gland at the junction of the gall-bladder and cystic 
duct, another gland at the junction of the cystic and common ducts, 
and several distributed along the course of the common duct. (Mayo). 
Jonas, of Omaha, has called our attention to a point in the nerve sup- 
ply. Branches from the four lower dorsal and two upper lumbar 
nerves pass along the diaphragm and send terminal filaments to the 
common and cystic ducts and neck of the gall-bladder. This ac- 
counts for the deep median pain of colic and spasm of the diaphragm. 

The inflammation may attack the ducts and gall-bladder together, or 
the one or the other in particular. In acute cholecystitis the inflam- 
mation of the mucous membrane of the gall-bladder usually stops at 
the cystic duct. So long as the inflammation is confined to the bladder 
there can be, no jaundice for there is no obstruction to the flow of bile 
from the liver to the bowel. Neither can there be swelling of the liver 
except possibly the formation of a linguaform process of liver over the 
gall-bladder, the so-called Riedel's lobe. The pain is localized to the 
gall-bladder. There is not apt to be temperature because a poor lymph 
supply hinders absorption. 

In a cholangitis, however, where there is more or less obstruction to 
the outflow of bile, we expect more or less jaundice, a swollen liver, 
sometimes pain, not limited to the gall-bladder, but diffused over the 
liver area, front and back, and, because of a richer lymphatic supply, 
more temperature. It is easy to understand then that where jaundice 
is present the trouble has extended beyond the gall-bladder and has in- 
volved the common or hepatic ducts. 



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14 THE CLINIQUE. 

Jaundice, if due to inflammatory swelling of the mucous membrane 
of the common duct, is usually not deep, is of short duration, and if no 
stone is present is not accompanied by pain. The jaundice due to stone 
in the common duct tends to be chronic, varying in intensity from 
time to time, but it is not so marked as in the case of compression from 
a tumor. Furthermore, the jaundice due to stone always has a history 
of pain at some time or other, though this may have been forgotten. 
Occasionally stone in the common duct has no jaundice and no pain. 

As gangrene and diphtheritic inflammation of the gall-bladder and 
suppurative cholangitis are comparatively rare in the absence of stone 
it will answer our purpose to proceed at once to the consideration of the 
results of infection — cholelithiasis. 

This condition is a disease of middle or advanced life, being very rare 
in young people. It occurs five times in women to one in men. Sta- 
tistics show that it is to be found in about ten per cent, of adults. It 
ranks first as a cause for abdominal distress in people of advanced life. 

The stones nearly always develop in the gall-bladder and their exist- 
ence bespeaks a pre-existing cholecystitis. Aside from infection, ob- 
struction to the outflow of bile is another cause, whether this obstruction 
is due to a mechanical blocking of the way from within the bile ducts 
or compression from without, or whether it is a mere stagnation of bile 
brought about through sedentary life, general atony, infrequent meals, 
pregnancy, etc. Therefore, stagnation of bile and infection of the bil- 
iary passages are the great and more direct general causes of choleli- 
thiasis. 

In ninety-five per cent of gall-stone cases there are no symptoms 
which call the attention of the physician to this region, because the de- 
veloping pathology has not interfered sufficiently with the functions of 
the parts involved. There may be stones in the gall-bladder, but the 
fluid contents of their container may find free drainage through the 
cystic and common ducts, and hence present no symptoms. It takes 
one or both of two conditions to excite symptoms: either interference 
with drainage, or infection. These are the cases which are apt to give 
rise at any time to the classical symptoms of colic, nausea and vomit- 
ing, slight, localized tenderness and rigidity over the gall-bladder, and 
the symptoms of occluded exit of bile from the gall-bladder. The du- 
ration of the symptoms depends upon the duration of the cause. The 
relief is usually obtained in a short time through the relaxation attend- 
ing a spell of vomiting. There is no jaundice, no temperature, and no 
increased pulse. You have seen these patients in perfect health stricken 
as suddenly as though with a flash of lightning, writhe in pain for a 



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THE CLINIQUE. % 15 

few moments or hours, then after a vomiting or retching spell be re- 
k lieved as suddenly as they were attacked. Five minutes after the at- 
tack, they feel as well as five minutes before the onset. 

These are the cases that are apt to be confounded with acute indiges- 
tion, first, because the pain may come on shortly after a full meal; and, 
.second, because they may disappear immediately after vomiting, but 
before and after these attacks the appetite and digestion apparently are 
perfect. The pain too, in gall-bladder cases, is referred tp the left and 
upward. Appendicitis may also come in for diagnosis, especially if 
there is a previous history of cramps of short duration. The pain, 
however, is not referred to the chest, centering more about the umbili- 
cus and lower abdomen, the localized sensitiveness and muscular rigidity 
too are over the appendix rather than the gall-bladder. It is rare to 
find the appendix up under the liver, but this makes the diagnosis very 
•difficult. Renal colic of the right side has the pain referred from the 
kidney posteriorly to the genito-urinary tract. Ulcer of the duodenum 
and stomach are very much alike in their symptomatology and both 
may resemble biliary colic more or less. Both may have violent at- 
tacks of gastralgia. Ulcer of the duodenum, and occasionally of the 
stomach, may have pain and tenderness in the right hypochondriac 
region, and both, especially ulcer of the duodenum, may have an 
accompanying jaundice. If the symptoms are a little irregular lead 
colic should be excluded. 

Where there is interference with the drainage the trouble begins. 
Supposing we have either a mechanical or inflammatory obstruction of 
the cystic duct, what happens? Acute cholecystitis, inflammatory in- 
filtration of the wails of the gall-bladder, exudation within its cavity, 
and distention of the bladder to a degree depending upon its elasticity. 
The localized tenderness and muscular rigidity will be present. Pain, 
temperature and pulse are apt to be increased and to be accompanied 
by chills. Jaundice may be present from the extension of the in- 
flammation to the common duct. The same conditions excluded in 
connection with simple biliary colic must also be excluded here. 

When the stone passes into the common duct it may possibly con- 
tinue into the bowel, but almost always lodges, giving rise to symptoms 
of common duct occlusion plus the infection which is quite certain to 
follow, or at least be exaggerated. There is of course pain during the 
transit of the stone, temperature and often chills, jaundice of variable 
intensity, and some swelling of the liver, but seldom tumor of the gall- 
bladder because occlusion of the common duct, if chronic, or chronic 
cholecystitis, almost always has an accompanying contraction of the 



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16 THE CLINIQUE. 

gall-bladder (80%). After a variable length of time the stone symp- 
toms in about twenty-five per cent, of the cases give way to a milder 
condition, which finds its expression through gastric symptoms, a little 
jaundice and a little temperature or occasional chills. 

Just as the chronic irritation of stones in the gall-bladder with the 
numerous attacks of inflammation lead to inflammatory infiltration and 
changes in the walls of the gall-bladder extending to the surrounding 
peritoneal surfaces and viscera with possible perforations, abscesses 
fistulae, etc., so a stone in the common duct leads to increased infection, 
on the proximal side of the obstruction, more or less ulceration at the 
site of the stone and a tendency to extension of the inflammation to the 
head of the pancreas, the portal vein, stomach, or duodenum. There 
is this difference, however, the constant flow of bile prevents the com- 
plete obliteration of the common duct, whereas the cystic duct may be 
completely obliterated, the gall-bladder then being in a condition of 
hydrops (providing the infection has died out and left only a serous 
fluid) or. empyema if the infection is persistent. If the cystic duct re- 
mains patent the gall-bladder contracts, whether there is stone in the 
common duct or not. Furthermore, obstruction in the common 
duct affects the ducts throughout the liver and consequently the organ 
as whole, often leading to hepatic cirrhosis; while in cystic obstruction 
the changes are quite limited to the gall-bladder except in cases of per- 
foration. Common duct cases in the great majority of cases have a 
contracted gall-bladder. The lymphatic supply . along the common 
duct being richer than about the gall-bladder and cystic duct permits 
more toxic absorption. 

In formulating a diagnosis of the cases rendered difficult because of 
a lack of classical symptoms and the presence of only symptoms which 
might easily be attributed to other conditions, I would like to call your 
attention to a few points. 

1st. Cramps or distress in the upper abdomen of a patient of middle 
or advanced life, especially if the patient is of the female sex, make us 
think first of gall-bladder disease. If actual pain is present it may be 
referred to the epigastrium, anywhere in the right chest, or simply 
across the abdomen, or into the back. 

2nd. Vomiting, sometimes associated with this pain or distress. 

3rd. A certain periodicity in the above symptoms. 

4th. Local tenderness more or less marked when deep pressure is 
made below the ninth costal cartilage of the right side. This pressure 
meets with a certain resistance from the upper right rectus. These lat- 
ter findings are constant in both inflammatory and calculus diseases of 
the gall-bladder or any of its ducts. (Murphy). 



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THE CLIN I QUE. 17 

These may be our only symptoms and only physical findings. Yet, 
if by all known methods of diagnosis, we exclude ulcer and carcinoma 
of the stomach and bowel or fecal impaction, nephrolithiasis, and move- 
able or floating kidney of the right side, and lead colic, there are few 
chances of its being anything else but a gall-bladder or duct case. Of 
course an appendix situated unusually high must be excluded, but the 
ordinary appendicitis is not going to offer great difficulties. There may 
be actual dilatation of the stomach from pyloric stenosis, but this must 
have a cause, so the stenosis and dilatation are both only results of some 
other primary condition — and must not mislead us. Another symptom 
which stands out alone in old, fat people, so far as the patient's com- 
plaints are concerned is an occasional chill, but the tenderness and re- 
sistance over the ducts and gall bladder is always present. 

Although the absence of signs of infection and jaundice should never 
direct our attention away from the gall-bladder and bile ducts their 
presence leads everybody in the right general direction and goes far to 
simplify the case. One of the worst cases of empyema with stones I 
ever saw, had neither temperature above normal nor a suggestion of 
jaundice. 

The periodicity of epigastric distress or pain, or " painful indiges- 
tion " is always an important point, especially if in the interval between 
attacks the patient eats and digests anything well. 

The common duct cases may occasionally have no pain and no jaun- 
dice, yet become so marasmic and cachectic that carcinoma cannot al- 
ways be excluded, in fact would suggest itself as the only diagnosis. 
Several mild attacks of colic with slight icterus occurring frequently 
rather indicates stone in the common duct. Two-thirds of the common 
duct cases show bile pigments in the urine and occasionally albumin. 

The presence or absence of jaundice is not always to be relied upon 
for most gall-bladder and cystic duct stones, and many cases of common 
duct stones, have no jaundice, or if they have it is only at intervals. 
Thirty per cent, of the common duct stones have no jaundice at the 
time of operation. Jaundice, if present, may not be due directly to 
either inflammatory or calculus obstruction from within, but may be 
due to compression of the common duct from without — plastic exudate, 
enlarged glands, tumor, etc. Naunyn claims that one-half the cases of 
jaundice ascribed to stones are due to carcinoma. Greig Smith says 
one-half the cases of obstruction in the common duct are due to stone. 

Mayo says that although he is sometimes unable to diagnose gall 
stones he may make a surgical diagnosis in cases with severe symptoms 
in the upper abdomen. 



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1 8 THE CUNIQUE. 

In diagnosing a gall-bladder tumor we must exclude right kidney, 
fecal mass or other tumor of the bowel and echinococcus cyst of the 
liver. Gall-bladder tumors blend with the liver, move with it in respir- 
ation and cannot be held down during expiration, as kidney or intes- 
tinal mass or other tumor can. A RiedePs lobe sometimes misleads. 
In considering tumors of vthe gall-bladder remember Courvoisier's law 
that in eighty per cent, of obstruction of the common duct due to stone 
there is contracted gall-bladder, while in ninety per cent, of enlarge- 
ment of the gall-bladder the obstruction is due to causes other than 
stone. In gall-bladder tumor any absence of jaundice means obstruc- 
tion of the cystic duct; one with jaundice obstruction of the common 
duct from tumor or cicatrix. An echinococcus near the gall-bladder 
might confuse, but its freedom from pain and tenderness and slow but 
steady growth, together with the findings characteristic of these cysts, 
should rule out gall-bladder. I once saw a large gall-bladder excised 
by a very careless operator under the mistaken idea that he had an ech- 
inococcus cyst. Carcinoma of the gall-bladder, if palpable, is found very 
hard and nodular, but unless the diagnosis is made early, more as an 
accidental finding, the diagnosis will prove of no benefit to the patient. 

What is going to happen if we do not operate ? Spontaneous cure or 
rupture into the hollow viscera or through the umbilicus is rare. Of 
the many possibilities in the way of serious results we may mention 
abscess of the liver, chronic interstitial pancreatitis, suppurative chol- 
angitis, septic thrombophlebitis, and, of great importance, carcinoma 
(4-14 % ). The chief dangers are perforation, cholangitis and carcinoma. 
A chronic jaundice effects the blood vessels in such a way as to cause 
hemorrhages. It also favors infection by reducing the resistance of the 
patient. Carcinoma involving the common duct causes death within 
six months (Ortner). 

The operative treatment has for its purpose two great objects: — First, 
the removal of stones; secDnd, the establishment of efficient drainage, 
then at the same time, if the patient's condition permits, the removal 
of such anatomical structures as will interfere with the complete success 
of the operation, as for instance, a gall-bladder or cystic duct so changed 
that it cannot perform its natural function in the future. Naturally 
then with stone confined to the gall-bladder, and with the latter in good 
condition and free from extensive surrounding adhesions, and with a 
patent cyst duct, cholecystostomy is the ideal operation for both imme- 
diate and remote results. This operation is indicated in acute cholecys- 
titis without stones as well. 

The ideal operation — incision and suture — is no longer practiced to 



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THE CLIN I QUE. 19 

any great extent because calculus bespeaks infection. If there is a 
stone in the cystic duct and cholecystostomy is the operation of choice, 
the gall-bladder should be opened before suturing it to the peritoneum 
because this will expedite removal of stone by manipulation from with- 
out. Let conditions arise, however, that will interfere with the elastic, 
ity of the gall-bladder, i. e. thickened, contracted walls, or that put the 
gall-bladder out of commission, as an obstructed cystic duct, or a duct 
so injured by operations that it is sure to become obliterated, or* gan- 
grene, phlegmonous inflammation, or carcinoma — then the advantage 
of its removal becomes evident, although the danger following the 
operation is at least twice as great as in ordinary cystostomy. Cystec- 
tomy is preferred to cysticotomy because the latter often leads to secon- 
dary cystectomy because of occlusion of the duct. Given the same 
local conditions cholecystostomy may be indicated in men while chole- 
cystectomy might be indicated in women because some of the former 
have their vitality reduced by alcohol and nicotine and their abdominal 
walls are more rigid and abdominal contents more fixed, (v. Berg- 
mann.) As a general rule cholecystectomy is indicated where fistulae 
«xist between the gall-bladder and intestinal tract unless the common 
duct is irremediably occluded. 

The danger of the fistulae is suppurative cholangitis, infection of the 
liver, etc. For this same reason, and because it is a difficult operation 
cholecystenterostomy is seldom performed. If cholecystectomy is in- 
dicated on general principles, but if the cholangitis or the condition of 
the patient is such as to make it too dangerous the Mayo operation of 
excision of the mucous membrane of the gall-bladder may be performed. 
If the cystic duct is not patent incise it to the common duct. If, how- 
ever, the gall-bladder is excised in the presence of existing infection 
the cystic duct should not be ligated because drainage is an absolute 
necessity. In case of ruptured gall-bladder, or any of its ducts, or in 
case of abscess, the infection is usually so great that one should, as a 
general rule, be content with drainage — as little operative interference 
as is absolutely necessary. 

Chronic cholecystitis, even .without stones, may be drained, but ex- 
cision can be called for on the same grounds as cases with stone. 
Stone in the common and hepatic duct calls for removal of the stone 
and tubular drainage, sometimes the tube being pushed into the hepatic 
duct. In 30 % of cases the stones are multiple. The great mortality 
ih these cases arises from the existence of jaundice and infection plus 
the coincident anemia in the chronic cases. Therefore, if you can 
operate during the quiescent stage (30% of the cases) the mortality 



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20 THE CLINIQUE. 

may be reduced four-fifths (2%). Stone in the common duct should 
never be crushed or needled because it is very apt to add to the intensity 
of the cholangitis. If the infection is already so great as to contra-in- 
dicate surgical interference with the duct, one should wait a reasonable 
length of time for the interval of quiescence; or, what seems by some 
surgeons as a better plan a cholescystostomy may be performed, or the 
hepatic duct drained as a preliminary measure. Then wait a few weeks 
before trying to remove the stone. 

Kehr claims that the hepatic ducts require drainage in thirty-seven 
per cent, of gall-stone cases. This duct may be drained with or with- 
out the removal of the. gall-bladder. Common duct stones occur in 
from fourteen and sixteen per cent, of all cases (Mayo) to twenty per 
cent. (Kehr and Robson). 

As Von Bergmann claims that the most experienced surgeons over- 
look calculi in ten to fifteen per cent, of the duct cases, the safest plan 
is to inspect all the larger bile ducts in every case of gall-stone opera- 
tion; and this can be done, he says, in ninety-eight per cent, of all 
cases. Because of frequently associated pathology of the pylorus, duod- 
enum and head of the pancreas these structures should be examined 
in all cases as well. 

In all cases of jaundice Robson administers calcium chloride prior to 
the operation. He advises 15 gr. doses every 4 hrs. for 2 days before 
operation. Others use this treatment only in cases of jaundice with 
subcutaneous hemorrhage. This is to prevent the fatal hemorrhage so 
often seen in chronic jaundice after operation. 

Carcinoma of the gall-bladder, if not too extensive should be removed 
by cholecystectomy, but the favorable cases of this kind will usually be 
those of accidental finding during gall-bladder operations. In suppura- 
tive cholangitis (Weil's disease) operation is hardly indicated. 



In injuries to the elbow-joint the rapid development of marked swell- 
ing frequently prevents the diagnosis of a suspected fracture or disloca- 
tion. Under these circumstances the plan suggested by Gerster and 
described by Dawbarn will prove of value when the X-ray is not avail- 
able. The patient having been anesthetized, an Esmarch elastic band- 
age is slowly and firmly applied from the hand up the forearm and over 
the elbow to the arm-pit. This is left on for about fifteen minutes and 
then removed from below tipward, the final turns upon the upper arm 
being allowed to remain. The removal of the edema in this manner 
permits of the recognition of a fracture or dislocation, and this having 
been accomplished, the upper turns of the bandage are removed. In- 
ternational Journal of Surgery. 



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THE CLINIQUE. 21 

HOMEOPATHIC ATTENUATIONS. 

M. R. FRENCH, M. D., CHICAGO. 

There is always more or less inquiry among the profession, as to the 
manner of potentizing our homeopathic drugs, or to put it in another 
way, developing the dynamic force. The starting point of this work 
is always, of course, the mother tincture, or the crude drug. These 
two preparations must be made in, the same way and under the same 
conditions as were the drugs that were proven, if the homeopathic or 
dynamic therapeutic action is sought for. 

Mother tinctures should be prepared according to the rules laid down 
at the time of their proving, as for instance, aconite napellus mother 
tincture is made by taking equal parts of the expressed juice from the 
living aconite plant j and homeopathic alcohol, this would make a tinc- 
ture of one-half drug power. 

Pulsatilla nig. mother tincture is prepared in a different way, or un- 
der the rules laid down at the time of its proving, namely one part by 
weight of the fresh plant pounded to a pulp and macerated in two parts 
by weight of homeopathic alcohol. The product which is drawn and 
filtered from this mixture is the mother tincture. 

The above are but two examples showing that there are well defined 
rules for making homeopathic mother tinctures, which when followed, 
yield quite a different product from those made by un -homeopathic 
methods. Having our mother tincture or the crude drug right, we 
proceed to make attenuations. Liquid attenuations, or dilutions, are 
started from the tincture by taking the appropriate amount of the 
mother tincture (according to its drug power) and the proper men- 
strum, (this latter may be either alcohol er water, or both) and giving 
it ten hard shakes. 

The next attenuation being made from the preceding one in the same 
manner. Both the centesimal (1 to 100) and decimal (1 to 10°) scales 
are used. If the drug to be attenuated is a dry substance, then it must 
be triturated, by using the proper proportion of the crude drug and 
sugar of milk, making the first attenuation, subsequent attenuations' 
being made in each case from the preceding one, (using either the 
decimal or centesimal scales), by taking the proper proportion of the 
drug and sugar of milk, and grinding it the required number of hours. 
All lx triturations must be ground four hours, or longer in some in- 
stances, subsequent triturations, two hours. 

Triturations are converted into liquid potencies, or dilutions, by dis- 



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22 THE CLINIQUE. 

solving 1 grain of the 6x in 50 minims, of distilled water, then adding 
50 minims of homeopathic alcohol, this gives the 8x attenuation. The 
next potency being made in the regular manner. 

There are three popular lines of potencies used in the profession, 
namely: TafePs, Skinner's, and Swan's. Tafel's may be had in the fol- 
lowing potencies, any strength up to, and including the 30th, also in 
the 200th, 500th, and 1000th, all made according to the centesimal scale. 
There are about 1000 Tafel's potencies ruu up as high as the 30th; 
about 300 run up to the 200th, about 150 run up to the 500th, and about 
100 run up to the 1000th. The Tafel's potencies are hand made, 
being run up step by step from the tincture, re-distilled homeopathic 
alcohol being used as the menstrum. Each potency receives ten hard 
shakes. 

The Skinner high potencies are machine made, the motive power be- 
ing water pressure. The menstrum which is used for potentizing is 
ordinary tap water, the succusion is obtained from the force, with which 
a thin stream of water is projected into a small glass bowl, containing 
at the beginning a drop of the mother tincture. When the glass bowl 
is filled to a certain point, the water is automatically shut off, the bowl 
inverted and contents emptied. Enough of the dilution adheres to the 
sides of the glass bowl to begin the next higher potency, which is 
started as soon as the bowl is righted and the water is automatically re- 
leased. Connected with this machine are five dials,, one tp register the 
potency from 1 to 100, another from 100 to 1000, another from 1000 to 
10,000, another from 10,000 to 100,000 and the last beyond 100,000, 
These dials indicate the actual number of times the glass bowl has been 
emptied, and thereby the potency that is in the bowl at the time the 
machine is stopped. It consumes 100 hours steady running for this 
machine to make the 1 Millionth potency. 

The Swan's potencies are made by a machine invented by Dr. Swan. 
It measures the amount of water that runs through it. The glass bowl 
does not empty in this machine as it does by the Skinner method, but 
several thin streams of water are squirted into it at different angles. 
There is but one dial on the Swan machine, which dial indicates the 
amount of water which ran through the machine, and this amount de- 
cides the potency that has been obtained. It takes only about four 
minutes and a half to make the one millionth potency by Swan's 
machine. 

Swan's potencies and machine are owned by Mrs. Swan, the widow 
of Dr. Swan, who was the inventor of the process, and are in the keep- 
ing of one of our large homeopathic pharmaceutical houses. There 



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THE CLINIQUE. 23 

are several other lines Of homeopathic potencies among which we may 
mention Jenichen's, which are made in Germany, and are little used 
in this country. 

Deschere's" in some ways are made similarly to the Skinner's, but are 
not as popular. 



THE NECESSITY FOR EARLY OPERATION IN APPENDICITIS. 

M. B. BLOUKE, M. D., CHICAGO, IU,. 

The position I take in regard to early operation in appendicitis is the 
result of conclusions formed after many years of conservative medical 
treatment. 

In the main I may say that treatment might be considered fairly 
successful, for I believe that a large proportion of cases of appendicitis 
are amenable to carefully prescribed homeopathic treatment, and to one 
who is a firm believer in that treatment it is hard to come to the con- 
clusion that the patient must submit to the knife. 

However, many of those who do recover from these attacks sooner or 
later have a recurrence of the disease and are obliged to submit to oper- 
ation, and in these cases of repeated attack show often we find upon 
opening the abdominal cavity firm and numerous adhesions, many 
times producing stenosis of the intestine so extensive that the patient 
can never be entirely relieved. Then again I have seen cases of gan- 
grene of the appendix within 24 to 48 hours from the time the first 
active symptoms of the disease made their appearance, and that too, in 
cases where it was least suspected. Such a case, if not walled off by 
inflammatory adhesions in Nature's effort to take care of it, must inevi- 
tably lead to septic infection, and in most cases to death. 

Who of us are able to diagnose such conditions in every case ? I 
doubt if there are any. And after witnessing so many of the conditions 
already referred to I am of the opinion that the only safe treatment to 
follow in appendicitis is the surgical, and that, as soon as a diagnosis 
can be made. This today is the conclusion of a large majority of the 
leading surgeons among whom is Wyeth who says: u In my entire per- 
sonal experience not a death seen which could not properly be ascribed 
to delay in timely and skillful surgical interference. Every case from 
the very beginning should be treated by a surgeon, with a medical at- 
tendant.' * 

Bernayssays: "As soon as appendicitis is diagnosed no matter how 



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24 THE CLINIQUE. 

mild the case may be, an immediate operation should be performed, unless 
a patient is in severe shock following a sudden "perspiration. In such 
cases the shock should be first overcome." 

J. B. Murphy, in speaking on " The Obligations of the General Prac- 
titioner, " says: " It seems to me that a man has no more right to hope 
that inflammation of the appendix, once instituted, will tend to a favor- 
able termination than he has to hope that an acute infective osteomyelitis 
of the femur or a phlegmon of the thigh will recover without liberation 
of the pus." 

" Is he justified in hoping that the case will subside and go through 
to a favorable termination ? No. We will admit that 80 per cent, of 
the cases recover from the attack, that 20 per cent, approximately of 
the cases either die in the first attack or have recurrences. If he de- 
cides to wait it is with the understanding that he is willing to sacrifice 
that percentage of his patients." U A11 aid can as readily be timely as 
untimely." u It seems to me that as a general practitioner I would 
feel personally responsible for the death of a patient suffering from a 
typical case of acute appendicitis, if I had the case from the beginning 
and was called early — that is in the primary pain." 

Murphy also says, " It seems to me that every death from" appendici- 
tis is chargeable directly to the people, either for not calling in the 
physician sufficiently early after the onset of the symptoms, or to the 
physician and surgeon for not acting promptly when they are called. 
I am sorry to admit that the latter represents the greater percentage," 
after such condemnation of the medical profession in general by a man 
of so great an experience in this disease as Murphy, I think it applies 
with equal force to the homeopathic profession because of our greater 
faith in the effects of medical treatment, and we are, or I may say, have 
been willing to take greater chances in the management of these cases 
on that account. 

I know that has been the case with me, but I am satisfied I have 
taken too great a risk. 



An excellent ointment for the treatment of boils is that recommended 
by Bulkley. It consists of carbolic acid, 5-10 grains; fl. extract of er- 
got, 1-2 dr.; starch, 2 dr.; zinc oxide, 2 dr.; and ung. aquae rosae, 2 oz. 
It is spread upon the center of a moderately thick layer of absorbent 
cotton, several times the size of the inflamed area, and secured with 
strips of adhesive plaster. This dressing can be left on for ten or 
twelve hours. — International Journal of Surgery . 



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THE CLINIQUE. 25 

Clinical Reports. 



THE SURGICAL TREATMENT OF CIRRHOSIS OF THE LIVER. 

BY DR. HOWARD R. CHISLETT, CHICAGO, ILL. 

• 

I have often asked myself the question why it is that surgeons see so 
few cases of cirrhosis of the liver when, according to the latest statistics, 
they are able to relieve from thirty to forty per cent, of such cases of 
the most distressing symptom, ascites. Is it because the physicians 
have too much confidence in their remedies, because they have not yet 
received sufficient proof of the surgical results, or do the patients them- 
selves refuse the relief when surgery is proposed because of the fact it 
entails operative measures? Whatever the answer to the inquiry, the 
fact remains that in consideration of what surgery has to offer in this 
distressing malady there are too many cases of cirrhosis denied its ben- 
efits. 

There are cases of absolute cure reported, some pathologists even 
having described regeneration of apparently destroyed hepatic cells, 
but the purpose of this paper is not to hold out as inducements results 
which, in the nature of the disease must be very exceptional, but to 
urge upon the medical men the fact that Talma's operation is in some 
instances the means of arresting for a time at least the further degener- 
ation of hepatic cells and in many cases the means of ridding the 
patient of much suffering. 

Without going into the pathology of cirrhosis we can state positively 
that the ascites is due to obstruction in the portal circulation and be- 
comes more and more pronounced as the liver undergoes its atrophic 
changes. This being true, common sense and clinical experience unite 
to emphasize the importance of advocating the early operation, that is, 
as soon as a fair trial of medical measures has proven them ineffectual, 
and before so marked an atrophy of the hepatic glands has taken place 
as to seriously interfere with the liver functions. Another reason for 
the early operation is the danger which is greatly augmented by the de- 
lay and the consequent necessity of operating upon one enfeebled by 
malnutrition and prolonged suffering. 

The object of the operation is simply to divert some of the blood nat- 
urally entering the portal circulation into the systemic circulation. It 
has been stated by some authorities that less than one-half of all cases 



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±6 THE C UNIQUE. 

of cirrhosis are troubled with ascites, a fact which is explained by good 
collateral circulation. To compensate for this lack in the other half 
Talma recommended the attachment of the omentum to the parietal 
peritoneum. There have been many modifications of Talma's opera- 
tion suggested, each having the object of increasing this collateral cir- 
culation. Some of these methods I shall describe later, but perhaps 
the most satisfactory manner of bringing this subject clearly before you 
will be the citing of a single case whidh is typical in history, in diagnosis, 
in operation and in result. For the patient, as well as the history I am 
indebted to Drs. N. B. Delamater and N. A. Pennoyer. 

History. — G. M., aged 53 years. An American of good stock and 
fortunately of a social and financial standing enabling him to take the 
best of care of himself. His occupation has been that of a wholesale 
dry goods merchant and for years he has been accustomed to traveling 
part of the time. There is no venereal history but patient has used 
tobacco and stimulants regularly for many years. Aside from the ordi- 
nary diseases of childhood lie has had many attacks trf indigestion and 
sub-acute gastritis. Fourteen years ago he had ulceration of the stomach 
accompanied with rather serious hemorrhages. From this illness the re- 
covery was complete the patient regaining normal strength and weight. 
During the winter of 1904 and 1905 there was a return of the gastric 
symptoms attended with rapid loss of weight and strength. He was 
sent to the Pennoyer Sanitarium where the following conditions were 
apparent at the examination: General emaciation; edema of the ex- 
tremities; color good; heart and lungs normal. Urinary analysis 
showed scant elimination, slight trace of albumin, a few hyaline casts 
and one fine granular cast. The abdomen was prominent, the area of 
hepatic dullness considerably diminished, ascites beginning and some 
mucus in the bowel movements. Patient was placed on a suitable 
diet, medication, eliminating baths and massage in spite of which there 
was no improvement save that the granular casts and albumin dis- 
appeared from the urine and the quantity of urine was increased. The 
emaciation continued, the ascites rapidly increased and the patient was 
failing so quickly that operation was advised and accepted. 

At the time of operation the examination revealed an enormously 
distended abdomen, edema of legs and scrotum, pleuritic effusion and 
slight pulmonary edema. The heart was in good condition and, con- 
sidering the amount of ascites, the kidneys were doing all we could ex- 
pect of them. After preparing patient for operation we inserted a 
trochar and withdrew twenty-five pints of slightly blood-tinged serum. 
The abdomen was then opened through the right rectus muscle above 



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THE CLINIQUE. 27 

the umbilicus. The peritoneum, both visceral and parietal, was so in- 
jected that it resembled the skin of a ripe blue plum. The liver was so- 
atrophied that I could scarcely draw it down for inspection even 
though the incision was so high. It was pale in appearance, leathery 
to the touch and in its entirety no larger than my two fists. The fat 
of the great omentum was so wasted that that organ looked like numer- 
ous dilated blood vessels tied together loosely by shreds of connective 
tissue. It was exceedingly difficult to handle on account of the sever- 
ity of the bleeding, but we finally succeeded in splitting it longitudin- 
ally, the right half being sutured between the convex surface of the 
liver and the diaphragm, and the left half to the anterior abdominal 
peritoneum, the end being brought out through the lower part of the 
abdominal incision and sutured to the subcutaneous fascia after the 
method of Schrassi. In this manner we hoped to secure the advant- 
ages of collateral circulation about the diaphragm as well as of both 
deep and superficial vessels anastomosing about the umbilicus. 

The surgical recovery was uneventful save for the accumulation of 
bloody serum in the subcutaneous pocket made for the omental pad. 
This exuded from the greatly distended omental vessels and was so 
bloody as to be quite a source of worry for a while. It finally ceased 
as collateral circulation became established. 

The subsequent history is very instructive. The operation was per- 
formed May 1st, 1905. On May 15th, in spite of diuretics and cathar- 
tics, the ascites had returned to the extent that we advised tapping fear- 
ing for the integrity of the wound. The amount of fluid removed was 
estimated at twenty-five pounds. On June 3rd the patient was again 
tapped the amount of fluid removed being thirty and one-half pounds. 
On July 5th we removed twenty-five and one-half pounds, Aug. 2nd 
twenty-three pounds, Sept. 6th nineteen and one-half pounds, a total 
of one hundred and forty-eight pounds in five months. During July, 
August and September the abdominal wall, the legs and genitals were 
very edematous and the ordinary diuretics were totally ineffectual. 
During these months Plumbum Acet. 6x was the main remedy but in 
addition the bowels were kept free and such remedies as Apocynum, 
Digitalis, Diuretin and Hydrogogin were used intercurrently. Each 
week the scales returned the bad news of a gain in weight of from five 
to seven pounds which, in the face of a progressive emaciation, had 
only one interpretation — fluid. 

The last week in September there was no increase in weight, the 
urine became free under the use of Anedemin, there was an increase 
apparently in the area of liver dullness and no evidence of pulmonary 



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28 THE CLINIQUE. 

edema. From this time there was no accumulation of fluid in the 
abdomen until December 15th when the last tapping was made and 
twenty-four ounces of fluid withdrawn. It was about this time I last 
examined the patient, seven and one-half months after the operation. 
He was of good color, there was no ascites, the superficial veins of the 
abdomen had become greatly distended, he had no edema anywhere and - 
was attending to business part of the day. The present condition of 
the patient, one year after the operation, is one of comfort in body and 
mind. All functions are apparently normal. The appetite is good, 
the patient is sleeping well and is feeling satisfied with a gain of five 
pounds which is not fluid. 

The lesson to be drawn from the tappings is, that it took four months 
for the collateral circulation to become sufficiently well established to 
prevent the recurrence of the ascites and I must confess that when six 
or seven weeks had passed without apparent improvement I began to 
feel pretty thoroughly discouraged, fearing the case had progressed so 
far that we could not justly expect a result. But that the result did 
come eventually even in this case of extreme atrophy makes me hope 
that so long as there is some hepatic function left we may expect re- 
lief if not the arrest of the disease. How this same patient would 
have fared had he been unable to command the best medical skill, the 
best nursing, the most nutritious diet and the best hygienic surround- 
ings, is a question. I believe he owes much to the medication and es- 
pecially to the restriction of liquids, the eliminating baths and the 
massage. 

The operation most often performed at the present day is the original 
one of Talma, suturing the omentum to the anterior abdominal wall 
after making a long incision, carefully removing all fluid and everting 
the peritoneum so as to attach the omentum over as wide an area as 
possible. He also advocates suture of the spleen to the abdominal wall. 
Eiselberg, to render the attachment more secure, advises the rubbing of 
the convex surface of the liver and the adjacent peritoneum with a rough 
sponge, treating the spleen and its neighboring peritoneum in the same 
manner and then suturing the omentum to the anterior abdominal per- 
itoneum which he has previously irritated with a rough sponge. 



It is a peculiar fact that post-operative prolapse through the epigas- 
tric wound occurs frequently in operations for malignant disease of the 
stomach. Such wound therefore should be closed with more than 
usual firmness and all possible precautions should be taken to guard 
against post operative vomiting. — American Journal of Surgery. 



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THE CLINIQUE. 29 

CLINICAL CASES. 

A. I,. BLACKWOOD, M. D., CHICAGO, ILL. 

Alumina in Intestinal Inertia. A nna L., aged 67, applied for treat- 
ment at the clinic October 12, 1905. She is spare, thin and dark com- 
plexioned. She complained of constipation of 30 years, duration. She 
had exhausted many so-called specifics for constipation, and is much 
ejnaciated and complains of feeling prostrated. There is loss of ap- 
petite; swallowing is painful and the mouth and throat feel dry. Upon 
careful inquiry it was found that the stools are not hard but soft, but 
the difficulty was in expelling them. An examination of the rectum 
showed it to be healthy. Alumina 30x, a dose night and morning was 
administered for three days when a placebo was substituted. In one 
week she reported much improvement. She was kept under observation 
and the treatment continued; later the remedy was given in the 200, 
and in six weeks we deemed her well and no further reports are re- 
corded. 

Cinchona in Anemia. Mrs. C, aged 38, came to the clinic Sept. 28, 
1905, complaining that she had been in poor health for several years. 
She was pale and stated that when rising suddenly, or stooping, she 
became dizzy and that at times she had fainting spells. Upon exertion 
and especially while ascending stairs she became breathless. She felt 
weak and tired continually. Her appetite was poor, and the thought 
of eating caused a loathing of food. When she ate, much gas was formed 
in the stomach and intestines, but belching afforded no relief. She 
was annoyed with a persistent throbbing and pulsating in the head. 
The stpmach and bowels were so tender that she could not endure the 
least pressure oyer them. The menses were too early and too profuse. 
The first day she was obliged to remain in bed, the flow was so great. 
She was worse from the slightest touch, from cold, motion, from mental 
exertion and from the loss of vital fluids. She always felt better from 
warmth and rest. An examination of the blood showed a high degree 
of anemia. Cinchona 6x q. i. d. was administered. On Oct. 5, 1905, 
she reported feeling much better, when the 12x was given. She was 
kept under observation for three months, at which time she was believed 
to be in a normal condition. The blood examination showed great im- 
provement. 

Natrum Sulphuricum in Morning Diarrhea. Grace C, aged 27, ap- 
peared at the clinic Oct. 5, 1905, complaining of a diarrhea which had 
been continuous during the past two years. It was worse when she 



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30 THE CLINIQUE. 

first arose in the morning. The desire came suddenly and was at- 
tended with much urging and a profuse emission of flatus. The diar- 
rhea was aggravated during damp weather and whenever she did any 
work in their basement, which is damp. In other respects she was 
well. Natrum Sulphuricum 200, three doses, was administered three 
hours, after which Saccharum Lactis was given. In one week she re- 
ported improvement, and weekly thereafter till Dec. 14, 1905, when 
she was believed to be completely well. 

Oleander in Iyienteric Diarrhea. Mrs. S., aged 44 years, had had a 
diarrhea for two years that has baffled every effort to control it per- 
manehtly. She is much emaciated and is termed a walking skeleton. 
It was only by the aid of her husband, that her case history could be 
taken as she is so forgetful; they say her u memory is weak," that she 
is unable to grasp your thought or to answer your questions readily. 
She complains of great weakness and dizziness, also a sensation of 
emptiness and exhaustion in the epigastric region after eating. The 
latter sensation is Relieved by taking a small amount of stimulant, 
especially brandy. The stools are liquid, yellow, sour and contain much 
undigested food that has been partaken of a day or two before. The 
passage of the stools is attended with the emission of large quantities 
of foul smelling flatus. Between the stools with the emission of flatus, 
small particles of fecal matter escapes. 

A physical examination revealed a slight dilatation of the stomach, 
with a tenderness along the line of the colon, but no general enterop- 
tosis. Oleander 12x was given three times a day and a diet consisting 
of milk, malted milk, soft boiled eggs, mutton broth and toast allowed. 
This was increased as improvement appeared. After two weeks the 
remedy was given in the 30x. In four weeks there were no undigested 
particles in the stool and recovery was uninterrupted. As this patient's 
diet had been regulated before, I believe this remedy must be credited- 
in curing her. Now after twenty months she is well. 

Tuberculinum in Pulmonary Tuberculosis. Mr. K., aged 52, came to 
the clinic Aug. 22, 1905. He has been losing flesh for several months, 
although eating well. He has a cough and expectorates a muco-pur- 
ulent material. He takes cold easily, much of the time without know- 
ing how. 

A physical examination revealed evidence of tubercular deposits in 
the apex of the left lung while the microscope showed tubercle bacilli 
in the sputum. Tuberculinum 200, three doses, was given three hours 
apart, and then Saccharum Lactis. He reported feeling better for sev- 
eral weeks, when on account of a yellowish, thick, excoriating discharge 



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THE C UNI QUE. 31 

from the nares and the expectoration of much the same material, with 
marked prostration, aggravation from exertion and cold winds, and re- 
lief from warmth, Arsencum Iod. 6x was administered three times a 
day, and later the 30x was given. The improvement continued. The 
•cough and expectoration has ceased, he has gained eighteen pounds, 
and considers himself well. 

Rhus Toxicodendron in Subacute Rheumatism. Mr. H. came to the 
clinic Aug. 23, 1906, and complained of a pain in the lumbar region 
that extended to the hips. Also pains in the knees and calves of the 
legs. The pain dates back two years at which time he was drenched 
with rain while overheated. The pains are worse during rest and when 
first attempting to move, and during cold, wet, rainy weather, at night 
and especially after midnight, and are relieved by continued movement 
or from a change of position and from warmth. Rhus Tox. 6x was 
.given. In one week he reported better, when the potency was changed 
to the 12x, and later raised to the 30x. Oct. 25th he claims he is per- 
fectly well, while later reports show him to be free from all distress. 

Rhododendron in Subacute Rheumatism. Mrs. H.,aged 37, has been 
a sufferer from chronic rheumatism for the past eight years. The pains 
are worse in the muscular and fibrous tissue about the joints. Worse 
^while at rest and relieved at once by motion. They are worse at the ap- 
proach of a storm, but better when the storm has commenced. She is 
always worse before a storm, especially if it is an electrical one. She 
was given Rhododendron 6x three times a day, with pronounced im- 
provement. Two weeks later the potency was raised to the 12x and 
later three doses of the 30x were given, and Saccharum Lactis with 
complete relief of all the symptoms. 

Myrtus Cheken in Chronic Bronchitis and its Sequelae. Mrs. H. 
aged 53, came under observation during November, 1905. She com- 
plained of a cough that had been of several years' duration. It was at- 
tended with the exptoration of large quantities of thick, sticky, muco- 
purulent material. The cough and expectoration are always worse 
during the winter months. 

A physical examination showed the barrel-shaped chest and all the 
evidences of emphysema, together with those of chronic bronchitis. 
The microscope showed staphylococci but in the sputum examined 
there were no tubercle bacilli. The cough was paroxysmal in charac- 
ter. There was shortness of breath, especially upon exertion. Myrtus 
Cheken lx, ten drops, was administered every four hours, with pro- 
gressive improvement till with the approach of the winter of 1906, she 



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32 THE CLINIQUE. 

is absolutely free from all cough and expectoration, and she feels better 
than she has in several years. 

Naja in the Cardiac Sequelae of Measles. Miss H., aged 16, came 
under observation during June, 1905. She had black measles four years 
before. The fever at that time was very high, and she was not expected 
to recover. Convalescence was slow. There was a low lingering fever 
present for some weeks following measles during which time she was 
weak and complained of irregular heart action and cardiac distress when 
attempting to move. At the present time the pulse is slow, and inter- 
mittent at times. The heart is enlarged and the muscular elements of 
thfe first sounds are deficient. Dyspepsia, with a choking sensation, is 
frequently present. She is frequently aroused from sleep with a sen- 
sation of suffocation, gasping and choking. There is present a hacking 
cough with but little or no expectoration. Naja 6x was administered 
four times a day with marked relief from the first, and ultimately com- 
plete relief of all the symptoms and the establishment of a normal heart 
action. 



A Diagnostic Methoi>— In the Sept. Journal of Obstetrics H. T. 
Hutchins, M. D., contributes a valuable and timely article on " Arti- 
ficial Renal Colic as a Means of Diagnosis." 

The method is applicable to the various indefinite pains, especially 
upon the right side in the abdomen, which so often are confusing, and 
aids in differentiating kidney pains from others within the abdomen 
and pelvis. 

The method is given in full and the results of the study of 100 cases 
tabulated. 

His conclusions are: 

I. The ability to reproduce, mechanically or otherwise, the pain of 
which a patient complains is always a most valuable aid in diagnosis. 

II. A definite and typical " Kidney pain " (renal colic) can be pro- 
duced in every instance by forcibly distending the pelvis of the kidney 
with a bland fluid. 

III. In a large majority of cases (98 per cent in our series), patients 
are able to accurately differentiate renal pain caused by the method 
described above, from pains from other causes. 

IV. By this method a diagnosis can frequently be made in a class of 
cases, as yet undifferentiated by the medical profession, whose symp- 
toms are vague and indefinite. 

V. Accurate measurements of the amount of dilatation of the pelvis 
of the kidney may be made with the instrument used, and by this 
means valuable data are obtained. p. c. 



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A Hopeful Sign.— The December number of The New England Med- 
ical Gazette comes to us with further evidence that there is a sincere 
desire on the part of some brainy earnest men of the two prominent schools 
of practice to get together and learn what each other hold of truth, and 
on what common ground they can unite in the science and art of med- 
icine. 

We print in another part of The Clinique, the paper which Dr. 
Richard C. Cabot, Instructor of Medicine in Harvard University, read 
before the Boston Homeopathic Medical Society in November, and trust 
that it may arouse the members of our school to a realization that the 
science of medicine is too broad to permit any one body of men to con- 
tain all of the truth pertaining to it. 

This paper brings the conviction that many of us will see the day 
when we will be united as physicians in the service of humanity and 
in the search for truth. As Dr. Cabot says, "we need to have more 
earnest, truth-seeking men," — and this is equally true of the homeopa- 
thic school, because for so long it has believed and maintained that it 
held the only true therapeutic law, resulting in lamentable bigotry on 
the part of too many of its adherents. 

We wish that such relations as exist between the two schools in Bos- 
ton might be made possible here in Chicago. As it is, the prominent 
men in both schools are content to plod along each pulling in his own 
way, instead of uniting to find a common ground on which to pull to- 
gether* v. R. 



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34 THE CLINIQUE. 

Our New Year Resolutions. — Every one has the right of making good 
resolutions whether he keeps them or not; in fact it is not expected 
that such determinations sliall be long lasting when made at the begin- 
ning of the year; somehow it comes natural at this time to make an 
effort at reform whether it is carried out or not. " And for that reason 
an editor is perhaps excused if he tries to reach a. high note even if he 
fails in the attempt. One of our first efforts will be to increase the cir- 
culation of The Clinique as much as possible and to this end we so- 
licit the good will of those who are interested in the same cause; our 
present distribution is already beyond the most sanguine hopes enter- 
tained in the beginning of the new enterprise, and yet we should reach 
out farther; every homeopath should help along the good cause and no 
better means is open for this purpose than patronizing the official or- 
gan. We trust that this resolution will become part and parcel of the 
good intentions of every well disposed physician who has a desire to 
start in the new year aright. 

Our second resolve will require the co-operation of our practicians as 
a whole; by this statement we refer to our desire to get more medical 
articles for publication; we have been criticised severely by our patrons 
in this regard, the majority claiming that we had too many surgical 
papers which do not help the average practician; we plead guilty in this 
respect, but it is the fault of our clinical men and not ours; we have 
sought more medical articles in vain and we hope this suggestion will 
receive earnest thought in the future. For some reason the surgeons are 
more prolific in writing and we cannot reject these articles, particularly 
when we are bound to publish all which are presented to the state soci- 
eties. There are, however, many able writers on the medical side who 
have been negligent of late; so kindly brace up, medical brother, that 
we may not receive the same criticism next year; the medical j>art 
of our profession is by no means remiss in its progress and we should 
be kept posted on all the new things in the medical world; it is partic- 
ularly requested that more articles of homeopathic character be sent to 
us, for we are frequently asked for publications of this character. 

Our next resolve is to cultivate as far as possible the shorter article. 
This is certainly an age in which the long thesis is overlooked as the 
busy practician, like the busy worker in all lines, seeks the concise re- 
ports of practice; for this purpose it is possible for every author to con- 
dense his writings and give the gist of what he has to say in a few 
words. In this way a greater variety of writings may be given to the 
profession and a greater degree of information, and advise may be dis- 
tributed. The officers of each society should cultivate this spirit for 



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THE CLINIQUE. 35 

this surely is the requirement of the times. It is quite evident that 
someone must censor the long article and it may become the duty of 
the editorial board to do this, much as we dislike to, and we trust that 
we shall have pome degree of support in that regard. 

We shall also make an effort to instill a greater enthusiasm in our 
medical societies, feeling that this is essential to maintain the proper 
standard and interest in our school of practice. * We therefore call upon 
the secretaries of the larger and the adjuvant societies to send in their re- 
ports promptly before they are too old for publication; we ask for the 
news and the papers read at each meeting so that they may be presented 
to the members before they are too old. We have a great many papers 
still unpublished, but if they were all more concise this would not hap- 
pen. We should all take an earnest interest in the perpetuity 
and progress of our societies from the American Institute down. 
It is probably true that we have too many societies and the question of 
concentration must some time be taken into consideration; there are 
too many dues to be paid and often the meetings conflict, but these will 
in time be regulated so as to meet all requirements. The local societies 
certainly have done a good work in the last year; they have presented 
exceptionally good papers; the meetings have been well attended and 
the best of fellowship has prevailed. Our state societies also deserve 
much praise, but for some reason they have not been so well attended a$ 
in the past; this may be due to the fact that they have been, held too 
long in one place and it is possible that a change in this custom ijiight 
be salutary. Our American Institute deserves special attention. . We 
have a live set of officers and a place of meeting which should be at- 
tractive; therefore we ought to expect a good meeting. Let every one 
make a special plan to be in attendance and therefore lend vim and en- 
thusiasm to the cause. The men who have made our school a success 
have contributed their best services to this society in the past and it is 
now our duty to contribute to its maintenance. 

So much for the general requirement of the profession; but there is 
still more for the individual to do; we should all turn over the new leaf 
and begin the new year's work with energy and determination to better 
the cause and improve ourselves; it is the duty of every professional 
man to improve his work as well as to contribute to the profession as a 
whole; after all it is the consensus of individual effort which makes any 
party strong and secure in its work; thus each member of the profes- 
sion should contribute his best service to the cause and thereby make 
himself worthy of being an integral part of the profession; this then is . 
the new resolution for us all to adopt, and to keep and thereby to make the 
new year, in every way, better than, the old one. h. v. H. 



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36 THE CUNIQUE. 

Court Testimony. — We had an object lesson not long ago in one of 
our city courts wherein a lady physician refused to testify inasmuch as 
she had not been called as an expert witness and therefore not paid for 
giving an opinion which certainly demanded a fee. In this particular 
instance the lady physician, being of good standing in the profession, 
defied the court to impose a fine for not testifying and though obliged 
later to apologize to escape prison punishment, she still did not furnish 
the required testimony; her excuse was to the effect that physicians are 
indiscriminately called into court without pay to give testimony of such 
character that it partakes of a professional opinion. More than this she 
claimed that hfcr time was constantly infringed upon in such instances 
to the great sacrifice of her professional appointments. 

While we all have an instinctive respect for our courts, we are obliged 
to respect our own rights as well; no one is more willing to serve man- 
kind than the physician, but there is often a limit to our feelings in this 
respect particularly when more is exacted of us than of other business 
and professional people; no one expects the lawyer to give his opinion 
without recompense even in court proceedings and no one would think 
of putting the business man to the same inconvenience. The physi- 
cian, however, is still supposed to give up everything for the sake of 
others and no one seems to think it incompatible with his position 
to require his opinion without pay; thus it seems reasonable for our 
profession to demand more consideration than has heretofore been 
given to us even in court. For that reason there is a degree of 
justice in the claim of this woman physician for protection of her pro- 
fessional accomplishment which certainly is her stock in trade. We 
have all been placed in similar positions to the detriment of our bus- 
iness and our special requirements; therefore it seems right to side with 
this physician, not in her disobedience to the court's demands, but in 
her objection to incriminate her own rights. We as a class are willing 
to give much of our service to charity but there are many instances 
when we should refuse to surrender our opinion which is our cap- 
ital, even at the demands of a lower court. Our rights in this regard 
should be understood and a martyr like this woman will surely call at- 
tention to our position. 

It is becoming a habit of cheap lawyers to send their cheaper clients 
to the clinic of some hard working physician and to get his opinion of 
their case gratis, and then call him into court without pay to swear to 
his statements regarding the case, or really to compel him to give an 
opinion free because the court requires it. To such a degree has this 
phase of action become a nuisance that clinical teachers must constantly 



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THE CLINIQUE. 37 

be on guard lest they be imposed upon. In our own experience, we can 
recall a case of a "prominent" lawyer going so far as to bring his sten- 
ographer to a clinic and take the lecture verbatim and then call the 
teacher before the court, in the case of a railway accident, without the 
slightest intention of recompense. These things are not right and 
should not be tolerated. 

Another court error is the habit of requiring a physician, in some 
states, to bear witness regarding testimony which has been given to him 
in the confidence of his calling; no true physician will do this, if he 
has to forget the facts which are germane in the given case. 

h. v. H. 



Newspaper Reform. — It is now more than a year since Collier* s 
Weekly began publishing its series of articles by Mr. Samuel Hopkins 
Adams exposing the various frauds perpetrated upon the public in the 
form of medical advertising. Such a complete and scathing exposure 
could not and has not failed to produce a considerable awakening of the 
public intelligence. But there is much educational work yet to do be- 
fore there is good prospect of seriously crippling this greatest of Ameri- 
can frauds. First of all must the medical profession and the medical 
press experience a decided awakening and assume something more than 
the present attitude of indifference. If the doctor is to pose as the 
guardian of the public health he must have a detailed knowledge of 
quacks and their methods and must give more intelligent answers than 
he usually does when questioned on the subject. 

The first important move in the matter has been made by a lay 
publication and was largely inspired by business considerations. 
These considerations will become less potent and a diminution of 
vigor is bound to result. Then will the nostrum vendor and the 
private disease quack begin circulating their nauseous literature in the 
same old cheerful way. And it will bring the same old fat returns. 
Already the more brazen of them are recovering from their temporary 
fright. Liquozone is buying space, the Peruna Company still peddles 
booze and old Father Pierce has actually turned his exposure to adver- 
tising account. 

The only hope of permanent benefit is that the medical profession 
will continue the work so well begun. Above all things doctors should 
not be deceived by the spacious pretenses of reform made by many of 
our great newspapers. Stung by the exposure of the close relation be- 
tween the newspaper and the medical fraud, and with a business re- 



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38 , THE CLINIQUE. 



o 



gafd for public opinion, many of these have made a pretense of clean- 
ing up their advertising pages and some have to a great extent done so. 
Others, however, are cleverly turning the subject into good advertising 
and without seriously curtailing their income from this disgraceful bus- 
iness. - - 

The Chicago Tribune recently published an editorial in which it 
assumed a most Virtuous pose and quoted with great' satisfaction a pas- 
sage from the Bookman in which it (The Tribune) was described as ! 
" free from Peruna money." It is evidently true- that at present -the* 
Tribune has no contract with the Peruna swindle bdt in the saiiie issue 
containing this virtuous editorial one can read without turning the 
page, a quack medicine ad containing as fraudulent statements as any- 
thing ever paid for with Peruna money. 

Continuing bur survey of this supposedly model newspaper we find a 
total of nine and one-half columns of display advertising for various 
medical fakes, making a list about as follows : Lydia'^inkham's Com- 
pound, Radway's Pills, Rainey Medicine Co., Powell's Deafness Cure, : 
Clarck Institute, Chemical Rupture Pad, Duffy's Whiskey, Cascarets/ 
Town's Cure for fits, Tonsiline, Peptol, Herpicide, Stuarts' Dyspepsia 
Tablets, Omega Oil, and De Miracle Hair Remover. These, together 
with several whole page ads for wildcat mining schemes, continue to 
swell the dividends on the stock in what calls itself " America's great-t 
est newspaper. " 

Truly there is yet need for popular education. b. h. 



\ The Tent Colony.— The Buffalo Rock Tent Colony has certainly 
made a marked progress in development since our last issue and it is 
bound to be a success. The opportunity has been given for every 
tuember of the profession ' to take stock in the Colony, even in small 
amounts if so desired; many have done so but the project cannot wait 
for those who are undecided and therefore subscriptions should be sent 
to Dr. JV P. Cobb without further delay. This is one of the most dis- 
tinctive homeopathic projects and will certainly be a credit to our 
school. « h. v. H. 



Do not be too hasty in making a diagnosis of intercostal neuralgia; 
With the exception of pulmonary and pleural conditions, ulcer of the 
stomach simulates intercostal neuralgia more frequently than any othei* 
lesion. — American Journal of Surgery. 



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THE CLIN I QUE. 39 

HOW FAR DO HOMEOPATHIC AND OTHER PHYSICIANS 
AGREE, AND HOW FAR CAN THEY AGREE?* 

BY RICHARD C. CABOT, M. D., INSTRUCTOR OF MEDICINE, HARVARD 

UNIVERSITY. 

* A new generation has grown up since the bitterest controversies 
were waged between the two main sects of our profession in this covins 
try. With this growth has come the disappearance of some of the, 
grounds of difference. Personal antagonism has largely disappeared.: 
I suppose no homeopath now receives from members of our school 'any* 
qi the social avoidance or, arrogant disdain which I am told used to be- 
meted out by the past generation. We -have learned that a. group ofc 
homeopaths are very .much like any other group of physicians. In' 
your school, as in our school, there are some fools, some fanatics and 
some knaves, but in your school, as in ours, there are those who are in- 
telligent, high-minded and eager for the truth wherever found. 

We have begun to me£t together for discussion both at the bedside 
and in scientific societies like this. We consult together and we study 
together. 

These are great gains attained by the growth of a spirit of tolerance 
and of truth-seeking on both sides. I shall not try to estimate which 
of the two sects has changed most. I am quite prepared to believe that. 
we have been more in the wrong than you, and that we have receded 
from more false positions than you have. But I am concerned more 
with the result than with the stages and processes by which" it was at- 
tained; more with the question of " Where are we now?" than with 
the route by which we have arrived here. I am not interested in in- 
quiring who is to blame. If you say that we, the old school men, are' 
greatly to blame, I will cheerfully admit it, and will search my conduct' 
for evidence of injustice or prejudice still remaining, — but my chief 
interest is with the present, not the past; with an attempt to get to- 
gether now, rither than with ah inquiry into the causes and delinquen- 
cies that have kept us apart hitherto. 

• I propose, therefore, to.begin with a recapitulation of the points of 
agreement gained so far, and then to suggest some items of work and k 
practice in which I hope we may agree still further. 

I. 

We agree, first of all, in those fundamental sciences on which the. 



*Read before the Boston Homeopathic Medical Society, November 1, 1906, and re- 
printed in full from The New England Medical Gazette. 



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40 ' THE CLINIQUE. 

practice of medicine is based, — physics, chemistry, biology, anatomy, 
and physiology, gross and microscopic, normal and pathological. This 
agreement is nothing new, but its consequences have not, I think, been 
fully recognized. For if we agree so far, we must also agree in all that 
can be strictly and legitimately deduced from the data of the fundamen- 
tal sciences. 

In so far as diagnosis, prognosis, or treatment are strict and logical 
applications of the anatomical or physiological facts of the case in hand, 
there can be no difference of opinion between our schools. "In so 
far "I say, and I am very well aware that it is not very far. Still, 
some examples are obvious. Physical, chemical, and biological diag- 
nosis, for example, are logical applications of the principles of physics, 
chemistry, biology, to the known data of anatomy and physiology. 
Hence it comes that on questions of physical, chemical and biological 
diagnosis we all agree nowadays. 

I do not know whether this agreement has always existed, but my 
impression is that diagnosis is one of the fields in which your schools 
and ours have been getting together more and more in the last ten 
years. This is a very great gain and presages still further agreements 
in the near future. 

II. 

Surgery is another example of a branch of the physician's art which 
is based directly on anatomy and physiology. Because the facts of an- 
atomy and physiology are facts for us all alike — we can and do agree 
on surgery. This, again, is especially true of late years and in this 
country. I find in some books by English homeopathic writers a spirit 
of hostility to surgery quite foreign to the attitude of members of your 
society in this vicinity, and I am told that homeopaths are having their 
cases of appendicitis with abscess operated on earlier nowadays than 
was the custom ten years ago. 

HI.. 

Hygiene and prophylaxis exemplify still further the extension of our 
basis of agreement as we apply further and further the principles of the 
fundamental sciences which all educated physicians alike acknowledge 
today. Hygiene and prophylaxis are simply the applications of bateri- 
ology and physiology to the problem of keeping well. The isolation of 
infectious disease, the destruction of the excreta of the typhoid and the 
sputa of the tuberculous patient are typical of the many important 
measures for protecting the public health in which there is no longer 
any disagreement between us. Dietetics, physical exercise and the full 



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THE CLINIQUE. 41 

use of our neglected birthright — fresh air — are taught and practiced by 
both schools alike, because they are deductions from the data of physi- 
ology. 

Whenever the treatment of a disease consists essentially in diet and 
good hygiene — as for example in phthisis — we find no considerable dif- 
ference in the practice of Homeopaths and Old School physicians. 

IV 

Wherever asepsis or antisepis is demanded, there is no difference be- 
tween . us. Surgeons differ, of course, as to the value of particular 
methods of sterilizing hands, instruments, dressings, and the field of 
operation, but there is no distinctive old school view or homeopathic 
view in such matters. 

So it is in diseased conditions where local treatment is indicated. 
Local diseases of the skin, of the mouth, and upper respiratory pas- 
sages, of the urethra, bladder, rectum, and female genitals are treated, 
I take it, by both schools on the same essential principles. 

Whenever chemical or physiological antidotes are demanded as, for 
example, in poisoning cases and in the neutralization of acid by alkali, 
we find all well educated physicians of both schools in substantial 
agreement. 

Mechanical therapeutics includes surgery, the application of ortho- 
pedic and other forms of apparatus, massage, manipulation, vibration, 
exercise, active and passive; do we not wholly agree in this branch of 
treatment ? 

I do not know whether Bier's method of treating joint diseases by 
the production of active hyperemia through heat, or of passive hyper- 
emia by bandaging, is properly to be described as homeopathic, but 
whether it is homeopathic or not, it is, I suppose, as acceptable to us 
all, because it rests on biology and physics, not on pharmacology. 

Heat, cold, counter-irritation, electricity, are applied by both schools 
alike. Radiotherapeutics is, I believe, considered a striking example 
of the homeopathic principle. If so, it shows the sprouting of home- 
opathic methods within the old school. 

My impression is that hydrotherapeutics and conscious psychothera- 
peutics are used more extensively by our school than by yours, but this 
indicates no difference in principle between us — for the good offices of 
water and mental influence are not the property of any school, and all 
physicians are sure to avail themselves sooner or later of any usefulness 
that there is in these methods. 

The beneficial effects of good nursing are not subjects for controversy, 



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42 THE CLINIQUE. 

and I suppose that outside the giving of medicine there is no difference 
between a Homeopathic and an Old School nurse. 

There remains two types of therapeutics regarding the homeopathic 
view of which I must ask you fo enlighten me — I allude to vaccination 
and to serum therapeutics. There are men in both schools who refuse 
to vaccinate or to give antitoxin in diphtheria. 

Are such persons relatively more numerous with you than they are 
with us ? I must ask you to answer the question for me, but however, 
this mathematic* problem may be settled, it seems to be the fact that 
there is no orthodox opinion among homeopaths against the use of vac- 
cination and antitoxic sera. • 

The use of tuberculin is a form of vaccination which illustrates better 
than any example known to me the approval of homeopathic principles 
in our school. Tuberculin is; of course, not an antitoxin, but a toxin, w 
and its therapeutic use is a form of vaccination. The , poison of tuber- 
culosis which can produce some of the symptoms of tuber- 
culosis is here applied in small .doses for the cure of tuberculosis 
through the production of immunity, or resisting power in the tissues. 
Surely, this is a case of " similia similibus curantur," as homeopathic 
writers have pointed out. The use of bacterial vaccination in infec- 
tious diseases recently produced by A. E. Wright is distinctly home- 
opathic. 

But the revival of tuberculin therapy within the past ten years (after 
its abandonment in 1890) illustrates the victory of another homeopathic 
doctrine within our school. I mean the doctrine of the occasional 
utility of very minute doses. No one in this country has had so 
much experience with tuberculosis as Trudeau of Saranac Lake. No : 
one has tested so critically and cautiously the merits and dermerits 1 
of this remedy. As arfciult of his fifteen years' experience of its use he' 
published last August an Account of his own methods, and ina'Tecent* 
letter to my friend, Dr. John B. Hawes, Jr. , he has amplified and reit- 
erated his statements in a mostHnteresting way. ■ " 

What does he use? Not the 10 milligrams often employed in the* 
early nineties — not even the 1 milligram or l / 2 milligram recommended ' 
later. At present * he begins his treatment in febrile cases with 
l-10,000th of a milligram and in febrile cases with a M00,000th of a* 
milligram. This l-100,000th of a milligram, when injected under the 
skin in a centimetre of water and absorbed into the circulation becomes 
diluted about 5,000,000 times by the body fluids. Hence we imagine- 
the original milligram of tuberculin acts in a dilution of 1-500,000,- 
000,000. What fixes this dose ? Precisely thfc homeopathic principle, 



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THE CLINIQUE. 43 

namely, to produce a definite good effect without any observable ill 
effects. 

- Of course I do not mean to imply that we have already reached an 
agreement as to the proper dosage of all, or even of very many, reme- 
dies. But we-have now observed the occasional utility of very minute 
doses, and you have long'sitice admitted the occasional benefit- of -very 
sizable doses. In principle, therefore, we already -agree. It remains 
to work oilt'the multitudinous details of the application of these princi- 
ples, t . . .c \ . • . 

We^sometimes follow the" maxijn; " Slnrilia siinilibus curantur, 1 ' but 
not often. You sometimes follow it, bttt not always. We strike -at the 
cause of -the disease arid Remove it whenever we can find that cause. 
So do you -whenever you are convinced that it is a cause^ as with in- 
testinal worms, fcrhead lice. Those of you who are convinced that qiiin- 
ine kills the malarial parasite in the blood 'just as a vermifuge kiHs an* 
intestinal parasite in the gut, use quinine for malaria, just as we do. 

We have come round -to your minute doses in some cases, and there 
is no knowing how much' further we may go. You, on the other hand,-' 
are not tied down to ihinute doses, but are quite ready to use larger* 
doses when better effects are obtained thereby. 

" " V 

■ f - THE SINGLE REMEDY. . . . . 

Let us turn now to another cardinal tenet of homeopathy — the single 
remedy. There we must frankly confess that old school practice has 
come much nearer to homeopathic usage within the last ten years. 
We, many of us, use but one drug at a time. "Drug" is never synon- 
ymous with remedy in* our terminology, and so* we should rather say 
that we often see several' remedies, e. g. , regulations of the diet, fresh 
air, exercise, hydrotherapy and mind-cure all at once, but with these 
remedies we prefer to combine not more than one drug — sometimes 
less. When I turn to some of the older books on therapeutics, some 
still used in our school, and see how the frail human stomach is ex- 
pected to bear not only the drug but an adjuvant, a corrective, a flavor-* 
and perhaps more ingredients, I rejoice that we no longer practice what 
some of our text-books Still preach. 

' There is tio longer any ground for discussion between us as to the : 
advisability 1 of giving but one drug at a- time. I think there is no 
longer any considerable difference between the practice of the two 
schools in this respect and in consultation with seven of your body, 
Drs. Sutherland, Batchelder, Rockwell, Moore, Carvill', Everett Jones, 



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44 THE CLINIQUE. 

and Hubbell, I have found entire agreement as to the advisability, in 
special cases of giving several drugs alternately to the same patient. 

Not long ago a meeting of this kind would be sure to attempt a dis- 
cussion of the bplief that Homeopaths treat symptoms while Old 
School practitioners treat the cause of the disease or the diseased organ 
itself. But in our time this, like so many other grounds of contro- 
versy, has vanished. 

You and we alike treat the cause of disease whenever we can find it 
(which, alas! is not very often. ) 

You and we alike extirpate a diseased organ by surgical interference 
when the symptoms appear to make such action advisable. 

You and we alike are often unable to locate the cause of disease, or 
even the diseased organ, and then you and we alike fall back upon the 
treatment of symptoms. None of us wants to treat symptoms if we 
can remove their cause. All of us are forced to treat symptoms when 
we can't find or can't remove their cause, — as is the case in the great 
majority of cases seen by any general practitioner. Sometimes" we 
treat the totality of symptoms — that is in our language, the evidences 
of disturbed functions, when we recognize, them, as for example, the 
dropsy, dyspnea, cough, palpitation, insomnia, nausea, oliguria and 
pain produced by passive congestion in uncompensated cardiac disease. 
Sometimes we are forced to treat a single symptom, like headache, be- 
cause we can't connect it with any other symptoms or with disease of 
any organ. 

We are all in the same box here and there is nothing to discuss. 

VI. 

A LAW OF THERAPEUTICS. 

It has been perfectly just to charge our school in the past with the 
absence of any principle or law in therapeutics, and to contrast the 
order and system of homeopathic treatment with the helter skelter 
omnium gatherum of merely empirical methods. But the contrast is 
no longer just. Homeopathy has a well-defined law which has been 
established [like all laws] empirically and is constantly and properly 
being subjected to re-verification through careful experiments. We 
also have at last, after much groping and long years of work obtained 
a law of therapeutics, a principle of therapeutic effort — namely the 
principle of immunity — natural and acquired, and of the means by 
which it may be attained, augmented, protected. 

To increase the power of the organism to resist disease is the aim 
of our diet-therapy, our hydrotherapy, our mechanical and surgical 



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THE CLINIQUE. 45 

therapy, our mind cure, rest cure, and work cure, our climatic and 
hygienic efforts, and of all the most satisfactory part of our drug- 
therapy. That this law is as wide as the law of similars, I think you will 
agree with me, for though it does not cover all our pharmacology it 
does extend over the other fields of our therapeutics where food, water, 
light, air, exercise, mind cure and even much of surgery find their 
place. 

Your principle does not yet apply to all cases. Neither does ours, 
Your principle is empirically built up and empirically verified; so is 
ours. We are not bound by our principle, nor by yours, but in both 
schools the principle guides research and stimulates discovery, which 
is the true function of a principle. 

Our views of the founder of homeopathy are far less divergent from 
yours than they were fifty years ago. We recognize now that in his 
day and generation he stood for a great and beneficent reform in medi- 
cine. The u gentle action" of homeopathic remedies and the "high 
regard for the unaided powers of nature" which is characteristic of 
homeopathy are in refreshing contrast with the violent and obviously 
harmful methods of Old School practice in Hahnemann's day. Had 
we lived in that age how fortunate would any one of us have been who 
fell into Hahnemann's hands and so escaped being bled, purged, puked, 
sweated and salivated, as was then the custom of our school. All this 
we now recognize. On the other hand, homeopaths no longer feel 
bound to defend everything in Hahnemann's system, and generally 
recognize that in many respects the science of medicine has not stood 
still since he died. 

Do I then think that there is entire agreement between our schools ? 
Not at all. We have come far towards you and you far towards us. 
Which has gone the further I do not know nor care, but we are still 
far apart in a portion of our pharmacology, and my purpose in the re- 
mainder of this paper is to indicate certain ways by which, I think, we 
can come nearer still. 

First of all, one thing is certain. There must be concessions on 
both sides — not only on your side, if we are to get together. We must 
admit that we have been wrong in the past and probably are still 
wrong in many points. We have certainly been wrong — some of us, — 
in our prejudices against homeopaths, in blaming all homeoapths for 
the faults of a few. I confessed to you a year ago how much surprised 
I was to find that there were homeopaths both honest and intelligent. 
Well, there are still a good many of our school who have not made the 
discovery, and it is high time that they should. I suppose there are 



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4 6 THE CLINIQUE,, 

also in your body some who find it • hard to believe that we of our 
school are not all arrogant and prejudiced. 

VII. ' 

SOME OF OUR MISTAKES. 

We have been wrong in the past in refusing to consult with homeo- 
paths and to join with them in state and national societies. But we 
have seen and admitted our wrong and are doing our best to get togeth- 
er with you wherever you will meet us now. 

We have been wrong and irritating in arrogating to ourselves the 
term of " regular " as opposed to homeopathic. You have .been kind 
enough to spare us more and more of late that ridiculous term u allo- 
path," and to call us by the neutral name of " old school." This is 
by no means a perfect designation for an up-to-date profession which in 
therapeutics has largely repudiated its past and now agrees with you in 
everything else. Still, in the interests of harmony I think .we should 
sacrifice something, and no one can help recognizing the arrogance of 
the term " regular." 

We have been wrong in saying and believing, as we often have, that 
there are no real homeopathists nowadays, none that really take Hahne-* 
mann's doctrine of similars seriously. One of the things that h^s most 
impressed me in my friendly and pleasant contact with homeopaths 
during the past year has been the studious care with which my. friends 
in your school endeavor to select remedies according to the law- of 
similars, and the unfeigned confidence which (in certain cases) they 
place in these remedies. ... 

We have been wrong in not admitting more candidly the ; bearing of 
certain well-known facts of pharmacology Qn the issue* between . your 
school and ours. The use of digitalis in relatively small doses to relieve 
symptoms similar to those of its overdose, the partial similarity between 
the symptoms of scarlet fever and those of belladonna poisoning, the 
supposed value of ipecac in controlling nausea (still stated in our text- 
books, though most of us fail to obtain any such effects) the .fact that 
you can produce some (by no means all) of the symptoms. of malaria 
by large doses of quinine and some lesions like tkpse of syphilis by 
over-dosing with mercury, that nitroglycerine will often produce and 
sometimes cure a headache — all these are facts which we should realize 
and whose significance we should study as far as we can. 

We have been wrong in experimenting so little as we have with 
homeopathic remedies. The whole question for us should be, do they 
work? Not long ago I suggested during a consultation that it- would 



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THE CLINIQUE. 47 

be well to try 1-25 of a grain of calomel in repeated doses for a toxic 
diarrhea in an old lady. The attending physician was horror stricken. 
" Why, that's homeopathy, " he said. " Well," I said, " it was sug^ 
gested to me by an old school physician, one of the best-known mea in 
this country, and he learned it from his father who was a homeopath. 
Let's try it, anyway." 

So we did try it and excellent were the results. 

We ought to be as free in using your remedies as you are in using 
ours, and in acknowledging publicly the good or the harm that results. 

VIII. 

SOME OF YOUR MISTAKES. 

Now, after these confessions, I hope I shall not seem arrogant when 
I venture to suggest certain changes to you; changes that might operate 
to remove sources of misunderstanding and irritation between our 
school and yours. I will begin with some trifling matters of nomen- 
clature which yet have their importance as causes of friction. 

I think you homeopaths are somewhat too tenacious in your hold on 
roots and stems — not in the botanical but in the linguistic sense. 

(a) The German word "Prufung" is a good word, but its proper 
translation is not " proving" but testing or experimenting. Proof in 
ordinary English means something very different from experimentation. 
When you speak of proving this or that, the impression naturally con- 
veyed is that you are demonstrating what is already true, as one does in 
geometry; whereas in medicine your effort is an open-minded search to 
find out what the truth is. The lawyer who can and will prove any- ' 
thing is justly called a liar, but if proof meant only test, the readiness 
to prove all things (as in the Scriptural usage no longer current) is 
most praiseworthy. 

I should suggest, then, that you no longer hold yourselves aloof from 
common usage, and translate in future the word " prufung " as the 
rest of the world translates it, namely as testing. Thus you will sound 
more open-minded and less dogmatic. 

(b) The Latin word " Cura" is not to be translated as cure, but as 
care. Of course you all know that as well as I, but I cannot help 
thinking that misunderstandings have arisen in the past because you 
have spoken of curing disease with a drug when you have realized as 
well as we do that nature does the larger part of the work, assisted more 
or less by our drugs and other remedial measures. 

To us, and I think to the public in general, a drug that cures a disease 
is a specific, yet I take it that Dr. J. H. Clarke properly states your 



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48 THE CLINIQUE. 

position when he says ( " Homeopathy Explained," p. 149). " In 
homeopathy we have, as I have shown over and over again, no specific 
for diseases." You cure diseases as little as the rest of us. You take 
care of the patient and promote his recovery by drugs and other 
measures. It sounds arrogant to say as homeopathists sometimes do 
that the old school palliates while homeopathy cures. It is, I believe, 
an over-fondness for stems and roots that has lead to this misunder- 
standing. Let us use the word " cure u only when we believe that we 
have a demonstrable specific for a disease, as we think we have in 
quinine and diphtheria antitoxin. 

(c) In naming drugs let us keep as close as we can to current usage 
outside the profession and cease to hold ourselves aloof. Let us call a 
spade a spade ; let us call corrosive sublimate by its christian name 
rather than by the stumps of two name like mere. corr. ; when we mean 
charcoal, let us not call it carbo ; when we mean sulphur and oyster 
shells, let us say so rather than cling to that curious relic "hepar 
sulph." When one means lime, why should one say calcarea? 

Now, I am quite aware that many of our own school are doing 
the same thing when they write their prescriptions in barbarous med- 
ieval Latin, or speak of nitro-glycerine as glonoin. But it is, I think, 
a mistake in all cases. 

(d) Finally, I think it would conduce to clearness in discussion, if 
both parties would be careful not to limit therapeutics, to drug ther- 
apeutics, for that accents unduly the differences between our schools. 
We agree not only in the diagnosis, prognosis and course of disease, 
but in the whole of therapeutics outside of drug therapeutics and in a 
portion of drug therapeutics itself. One of our chief grounds of differ- 
ence, and one not always appreciated by homeopaths is in the relative 
importance of drug therapy as compared with other forms of treatment. 
The best men of our school today use far less medicine, I should judge 
— even in actual bulk — than you do. The chief issue between us is not 
between homeopathic drugging and old school drugging, but between the 
old school physician with very little emphasis on drugs and very much on 
hygiene, dietetics, mechanical, physical and psychic therapy, and the 
homeopath who adds to a certain belief in these remedial agents a much 
larger belief in drugs. I doubt if you gentlemen realize how large a 
proportion of our patients are treated without any drugs at all, and how 
little faith we have today in the curative power of drugs. I think most 
men of our schools today would say that the only diseases really cured 
by drugs are malaria, diphtheria, myxedema and those due to intest- 
inal parasites. 



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THE CLINIQUE. 49 

Gentlemen, we want the truth, all of it that we can get hold of. So 
do you. Two ships that steer for the same port are sure to come to- 
gether sooner or later, no matter how far apart they may be on the 
ocean. If we keep ourselves in this mind, if we are fair and honest and 
not uncharitable, we shall pool our knowledge some day and abolish 
sectarianism in medicine. I hope and pray that this consummation 
may come in our lifetime. Whether it does or not depends largely 
upon us — our earnestness, our honesty and our good will. 



MOVABLE KIDNEY; A SURGICAL REVIEW.* 

FILIP A. FORSBECK, M. D., MILWAUKEE, WIS. 

The physical disability known as floating kidney, is universally con- 
considered from a surgical point of view. 

As the pathologic changes in the kidney tissue itself are secondary or 
asssociated with it as a result of other systemic defects, a resume of this 
subject from the standpoint of a surgeon, may exclude such features as 
are properly discussed under the heading of pathology. 

For whatever functional or structural changes that may have taken 
place, relief must be sought in the properly indicated remedy, after 
normal anatomical relations have been established. This review will 
therefore confine itself to the diagnosis and treatment. And even these 
are so well expounded in the modern textbooks on surgery, that in 
order to lend interest to the subject, there must of necessity be added 
such commentaries based on persoiial experience as will illustrate cer- 
tain variations from the ordinary, stereotyped case as described by the 
author. 

The degree of dislocation is of primary interest. When upon deep 
inspiration the kidney can be felt in its normal position and moved 
slightly fofward and backwards, the organ is simply styled " palpable.' ' 

Again when under the same conditions the kidney can by the bi- 
manual touch be moved forwards and downwards and the examining 
hand on the abdomen can by deep pressure be placed above the organ 
and hold it down, the kidney is called " movable,' ' and finally when 
the kidney can be grasped and readily brought below the costal arch 
and forwards so as to give evidence of its presence by a distinct contour 
of the abdomen, the organ may indeed be called " floating." This 
latter condition is rare, but the former quite common. At all events 
♦Read before the Homeopathic Medical Society of Wisconsin. 



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50 THE CLINIQUE. 

the extent of mobility is dependent on the condition of the fatty capsule 
and the length of the renal vessels. 

The etiology of this condition is in the majority of instances very 
vague. 

Practically all cases have as causative factors mechanical disturbances 
such as falls and blows, or debility from wasting diseases, or pressure 
from within or without, all of which are of interest in establishing a 
diagnosis, but of little importance in the treatment of the disease. 

In neurasthenic patients mobility of one or both kidneys is said to 
be the rule, and then mostly associated with general enteroptosis. 

The diagnosis is the feature, and a correct diagnosis is not always 
made at first examination, particularly if the symptoms are obscure. 

Most prominent of these is the sensation of bearing down or heavi- 
ness in the side below the margin of the ribs. 

This symptom is relieved when the patient is placed in recumbent 
posture, and this fact, together with the return to the normal place of 
the dislodged kidney, when the patient is in this position, forms the 
most important diagnostic sign. 

The recognizing of a movable kidney by palpation, is however more 
easily said than done. 

The " smooth movable tumor, shaped like a kidney," as the text- 
books give it is very frequently neither smooth, movable nor shaped 
like a kidney. 

I believe that in great many instances of floating kidney, the phy- 
sician overlooks the importance of even making a physical examination 
and thus errs in his diagnosis and the patient goes on unrelieved. 

I have met and operated on several patients who never dreamed of 
being possessed of a floating kidney, but went their way satisfied of 
having to contend with a chronic, incurable stomach or liver complaint 
because a correct diagnosis had not been made. Palpation over the 
kidney must be done repeatedly in order to firmly establish the fact 
that the kidney is out of place. 

In cases of extreme mobility the fatty capsule follows the kidney and 
the feeling elicited then by the bimanual touch is deceptive and any- 
thing but smooth. 

Again we are told that u the kidney can readily be pushed back in 
place. " 

This may be true in the acute or milder forms but is dependent on 
several conditions. 

The organ may become permanently misplaced and anchored in its 
new^position by the agglutination of tissue, and in such instances an 



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THE CLINIQUE. 51 

attempt to replace it will result in pain from the stretching of these ad- 
hesions, and a replacement of the organ will be impossible. If the 
patient is a fleshy subject particularly a woman with high crests of the 
ilia it is very difficult to outline the kidney in its malposition, much 
less return it to its normal relations. I judge that in ninety percent of 
cases there is pain on deep pressure, dependent largely on the degree 
of prolapse. In very severe cases the pain may become exruciating 
particularly when the ureter becomes bent upon itself and retention of 
the urine takes place with consequent enlargement of the ureter or pel- 
vis of the kidney. 

In the case of Miss B. , upon whom I operated some three months 
ago this was particularly well illustrated. 

She had been sick for several years, but up to within three weeks of 
the operation had suffered little pain, but more a feeling of weight and 
discomfort in the right hypochondriac region. 

Suddenly one day she was taken ill with chills and fever terminating 
in the evening in a spasm bordering on convulsions, with unconscious- 
ness for several hours. This was repeated every day for three weeks. 
During this time a decided cystic tumor would be present in the region 
of the kidney, even to the extent of causing bulging of the abdomen. 

It seems that when the ureter and pelvis of the kidney had been dis- 
tended to a certain point, the twist in the ureter would become relaxed 
and the accumulated urine would flow out, the tumor disappear, con- 
vulsions cease, and consciousness return. 

I had the opportunity of observing this procedure for three days be- 
fore consent was given to operate. 

During the three weeks just mentioned and for months prior thereto 
this girl was treated for stomach, bowel and ovarian diseases and even 
while these paroxysmal attacks of twisting of the ureter with consequent 
accumulation of the urine and a decided tumor-like contour over right 
hypochondrium were present, the true nature of her affliction had es- 
caped the diagnostic skill of several physicians. 

And this in spite of the constant soreness and severe pain on pressure 
over the renal region. Operation gave immediate relief. This inter- 
mittent hydronephrosis is fortunately very rare even in cases of long 
standing. 

In his lectures on u Abdominal Tumors M delivered to the post grad- 
uate class at the John Hopkins University, Osier refers to only three 
cases in his own experience. 

It is of interest to note that in my experience there was in no instance 
any evidence of change in the urinary excretion though the urine may 



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52 THE CLINIQUE. 

become highly colored and contain an excess of uric acid, oxalates, 
blood and even pus, as reported by Gaillard, Thomas, Flint, and others. 

Other symptoms such as chills, fever, vomiting, and a " sickening'' 
feeling particularly on sudden motion etc., are concomitant, though not 
present in all cases. 

In fact cases have been reported of extreme mobility without any 
symptoms whatever. 

A case of unusual interest occurred in my practice in May, 1905. 
Mrs. L. had complained for six months of a tumor gradually growing 
larger in the left ovarian region without any other symptoms except 
occasional darting pains ascribed to the ovary. She presented no symp- 
toms indicative of any renal complications and being satisfied with the 
diagnosis after having received the same opinion from several phy- 
sicians who were called in consultation she went to the hospital, with 
the expectation of being relieved of an ovarian cyst. 

The case fell into my hands for operation and on opening the peri- 
toneum the wall of a cystic tumor presented itself. The aspirator re- 
lieved the cystic part of the tumor, and finding a solid mass readily 
movable, I introduced my hand to locate its base or pedicle and found 
to my surprise the broad ligament, uterus and ovary absolutely normal. 
The pedicle sprang from the side of the pelvis. Presuming it to be 
independent of the abdominal viscera I removed the " adhesions" 
which I afterwards found to be the posterior wall of the peritoneum and 
ligated and cut off the pedicle. The tumor proved on section to be a 
sarcomatous kidney with almost the entire kidney substance disinte- 
grated. The patient made an uneventful recovery. 

It is quite remarkable that this dislodged and diseased kidney could 
have evaded the diagnostic attempts of so many doctors including my- 
self. 

But the absolute negative symptomatology and history of the case 
relative to renal involvement will explain the error, in diagnosis. 

Therefore when you are satisfied of a correct diagnosis, hope for its 
verification but be prepared to meet any contingency that may arise. 

I will not attempt in this short paper to outline the points of differen- 
tial diagnosis between this condition and the many similar ones for 
which it may be mistaken, as this subject alone is worthy of more con- 
sideration than the time alloted me would permit. 

I have however made such observations and notes, in the cases that 
have come to my notice as would warrant me to return to the subject at 
some more opportune time. 

After a diagnosis of floating or movable kidney has been made there 



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THE CLINIQUE. 53 

is only one means of cure, viz., fixation. There is little or no hope in 
internal medication or external appliances. The question is simply one 
of practice. Will you give your patient the benefit of good judgment 
and good practice with hope for a speedy cure or vice versa? The prog- 
nosis as to life is favorable in all cases. The percentage of mortality is 
about one, and the percentage of failures is about twenty, and these are 
due mostly to existing conditions or complications, making the opera- 
tion difficult to perform with perfect nicety. 

My personal experience in a number of cases in my own practice and 
in the cases sent to me for operation from different physicians in 
the state, has been very gratifying and I have made particular effort to 
follow these cases up and make record of the results. 

The operation of nephrography or nephropexy was first performed 
about the year 1885 and is consequently one of the later additions to 
surgical practice. 

The technique is delicate but not complicated and admits of few vari- 
ations. 

In reaching the kidney the usual incision is made in the lumbar 
region commencing two inches from the vertebral spine and one inch 
below the margin of the last rib and is carried downwards and out- 
wards towards the anterior superior iliac spine stopping about an inch 
and a half above this point. 

The retro-peritoneal space being opened, the kidney is pushed in 
position and held in place by a tenaculum, while the anchor sutures are 
introduced. 

In doing this I follow the method described by Hahn, who first per- 
formed the operation, and improved by Guy on, in passing the sutures 
through the fibrous capsule alone, after first splitting it along its convex 
border. 

The edges are thus by catgut attached to the muscles at the edges of 
the wound, and granulations allowed to form and become attached to 
the kidney tissue itself, stripped for a couple of inches of its capsule. 

The including of the parenchyma of the kidney has not proven of 
any great advantage, as evidenced by statistics. In my own experience 
I have found no necessity for it. It might be apropos to reiterate here 
the words of Tuffier: " Every effort should be made to save (and I 
add, from injury) all the noble tissue of the kidney that may be of use 
to the organism." The wound is packed and allowed to heal by gran- 
ulations. In uncomplicated cases the patient may be discharged in 
three or four weeks. 



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54 THE CUNIQUE. 

In a review of this condition and the remedial means employed for 
its cure, I have drawn the following conclusions: 

1. Though a prolapsed kidney is always a functionally crippled organ, 
through the interference of its circulation, the systemic well-being of 
the patient is reasonably well preserved by virtue of the return of the 
kidney to its normal relation and function while the patient is in the 
recumbent posture and because the burden of the urinary secretion is 
always shared by the other kidney. 

2. The constant interference of the normal circulation in a dis- 
lodged kidney will ultimately result in a permanent congestion or en- 
largement of the organ, at first only while in the faulty position and 
later also while the patient is in bed and the kidney replaced. 

3. Eventually acute inflammation will set in and this together with 
the arrest of the urine within the kidney from the mechanical obstruc- 
tion of a flexed ureter may result in perinephritis, hydro-, and pyone- 
phrosis and inevitable destruction of the organ. 

4. The earliest possible permanent restoration of the organ to its 
normal relations by anchorage as has been described will prove ab- 
solutely curative, unless the structural changes in the kidney have pro- 
gressed too far. 

5. External appliances and other palliative measures are useless if 
not actually injurious. 

Through the pressure which must .of necessity be exerted in order to 
accomplish the object of the application of pads, belts and the like, con- 
gestion will rather increase and the very fact of temporizing by attempt- 
ing to give relief by these means, may bring the condition to a state 
when even surgical measures cannot save. 

6. The support expected by the fatty capsule is generally over- 
estimated, for unless this tissue is adherent to the retro-peritoneal space 
no matter how great its volume, it will be of no avail. Consequently 
an attempt to rebuild a debilitated system by rest in bed and to increase 
the adipose tissue will not serve as a remedy unless fixation of the cap- 
sule is done which cannot be accomplished except through surgery. 

7. Statistics have shown that there is practically no risk in the opera- 
tion, that the percentage of failures is very low and that the ultimate 
cure depends simply upon how long the condition has existed, and the 
extent of injury suffered by the afflicted organ. 

8. Post-operative treatment by medicinal agents to establish the nor- 
mal functions of the kidney is at last indicated. 



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THE CLINIQUE. 55 

THE ILLINOIS STATE HOMEOPATHIC MEDICAL SOCIETY. 

The committee on organization which reported a general outline of 
proposed work in the November issue of the Cunique has been con- 
tinuously at work in its effort to forward the interest of the whole 
homeopathic school in Chicago and State of Illinois, and now has 
reached a point where it wishes and solicits the assistance and co-oper- 
ation of every homeopathic practitioner in the State. 

The work of organization is beset with many difficulties, and in or- 
der to facilitate matters and to answer such queries as may readily sug- 
gest themselves to the mind of every wide-awake practitioner, the fol- 
lowing information is given: This movement is from and of the Illi- 
nois Homeopathic Medical Association and is not sectional or sectarian 
in any sense, but is for the good of every individual in the State. 

Following is the committee: 

Dr. S. H. Aurand, 717 Marshall Field Bldg., Chicago, Chairman. 

Dr. Mary E. Hanks, 20 Bellevue Place, Chicago. 

Dr. O. B. Blackman, Dixon, 111. 

Dr. W. P. Armstrong, Springfield, 111. 

Dr. Edgar J. George, Marshall Field Bldg., Chicago. 

Dr. E. C. Sweet, 70 State St., Chicago. 

Dr. A. C. Tenney, 453 W. 63d St., Chicago. 

Dr. Frank Wieland, 70 State St., Chicago. . 

Dr. I. O. Denman, Charleston, 111. 

Dr. N. B. Delamater, Marshall Field Bldg., Chicago. 

This committee serves as a connecting link between the state and local 
organizations. * It is the duty of this committee to assist in organizing 
new societies and in maintaining those which are already organized and 
it is your privilege to request the co-operation of this committee in your 
society work and in forming new organizations. To these ends the 
several members of the above committee have been assigned to the 
various districts where it is thought they can be of the most service, and 
any homeopathic physician may obtain their assistance and co-operation 
by addressing any of them they may know personally or by addressing 
the chairman, Dr. S. H. Aurand, Marshall Field Bldg., Chicago. • 

The history of this movement is simple, although it has received the 
thought of those who are interested in the larger intesests of homeo- 
pathy, for some time. 

At the last meeting of the state association many expressed the idea 
that the gulf between the state and local organizations was not properly 
bridged and that the present condition of organization did not lend it- 



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56 THE CLINIQUE. 

self readily enough to an adequate consideration of the interests of all 
branches of our school. Further, it was thought that there was lack of 
unity and support when movements pertaining to legislation and the 
medico-legal interests of practitioners were being instituted. 

To obviate a continuation of these conditions the above named com- 
mittee was appointed and they have had several meetings at which all 
phases of the situation which could be presented were discussed. At 
the preseut time, with the accepted division of duties this committee is 
at your service and open to suggestion. The committee on its part 
has the following suggestions to make under various heads as follows: 
For Medico-Legal Protection — Let the secretary of your society corres- 
pond for information with the medico-legal committee of the Chicago 
Homeopathic Medical Society. Address Dr. N. B. Delamater, 31 
Washington St., Chicago; Dr. J. P. Cobb, 42 Madison St., Chicago. 

For Legislative Affairs — Appointed a committee on legislation to con- 
fer with like committee from other local societies and the state associ- 
ation at the next annual meeting, and give them power to act, and such 
instructions as are deemed advisable. By this method all matters of 
this nature would be thoroughly convassed in committee and your leg- 
islative committee would be fully informed as to how, when and why 
various movements should be instituted. 

Financial Affairs — For reduction of societies' fees, dues and expense, 
a committee on "ways and means' ' from each society should meet like 
committee at the next state meeting. Further, all matters of organiza- 
tion for establishing a direct connection with the state association, and 
through it, with all other societies in the state could be placed in the 
hands of the "committee on ways and means." 

To every homeopathic practitioner who is too far removed from lo- 
calities where it is convenient to attend any of the meetings of the es- 
tablished societies this committee on organization is especially anxious 
to render assistance. Large areas of our state are without an organized 
local society. These societies are great of value to the general practi- 
tioner and every assistance which can be rendered toward forming new 
local societies will be given gladly. Lists of names have been compiled 
and available meeting points have been suggested, all of which are 
yours for the asking. 

Letters on these subjects should be addressed to some one of the above 
named committeemen and in order to facilitate matters it is suggested 
that in writing the writer give his college and year of graduation, so that 
he may be informed as to where those most liable to assist him are 
located. 

A good beginning has been made, let it progress rapidly. 

Yours fraternally, 

Committee on Organization. 



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THE CLINIQUE. 57 

CHICAGO HOMEOPATHIC MEDICAL SOCIETY. 

The 101st regular meeting of the Chicago Homeopathic Medical So- 
ciety was held at the Northwestern University building on Thursday, 
Nov. 15th, 1906, at 8:30 p. m. 

The minutes of the previous meeting were read and approved. The 
name of Dr. J. H. Raach of Wheaton was proposed with the permission 
of the censor and was accepted for membership. 

Dr. Gilbert Fitz-Patrick, representing the Clinical Society of Hahne- 
mann hospital, read and presented to us for future action, a communi- 
cation proposing affiliation of the two societies. 

The Englewood Society, represented by Dr. Ingersoll, also reported 
a similar project. 

A motion was made by Dr. Costain, seconded and carried, " that the 
president appoint a committee of three to arrange the details of affilia- 
tion." The question was discussed by Drs. Delamater, Brown and 
Gurney. Dr. Shears proposed the amended motion, "That the com- 
mittee should confer with the different homeopathic societies in this 
community, to ascertain if they wish to affiliate as subsidiary branches 
of this as the parent society. " The amendment was carried unani- 
mously. The president appointed the secretary and treasurer to act 
with him on the committee. 

The bills for printing, postage and rent were presented, and the 
treasurer was instructed to pay them out of funds of the society. 

Dr. Shears read a letter from the county commissioner, Mr. E. J. 
Brundage, concerning the appointment of homeopathic internes in Cook 
county hospital. Dr. Shears presented the following: 

" Resolved, that the president and executive committee of this soci- 
ety be authorized to act with similar committees of other Homeopathic 
societies in this city, to do as they thinkbest to secure the appointment 
of Homeopathic Internes in Cook County hospital." This was adopted 
by unanimous vote. 

The program included a most scholarly paper by Dr. C. E. Kahlke. 
presenting the latest research in regard to the Pathology and Treatment 
of Goiter. The paper was discussed by Drs. Aurand, Brown, and 
Shears. Dr. Kahlke closed the discussion. 

The second paper was read by Dr. H. P. Skiles on the subject " The 
Unknown Quantity in Medicine.' ' 

The discussion was by Drs. Sarah Hobson, Julia Homes Smith, Gur- 
ney, Brown and Wieland, and was closed by Dr. Skiles. 

The meeting adjourned at 10:15 p. m. 

G. M. McBean, Secretary. 

Frank Wieland, President. 



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58 THE CLINIQUE. 

REPORT OF THE COMMITTEE ON DRUG PROVING. 

C. G. FELLOWS, Chairman, read the report of committee of the 
society on drug proving. 

Your committee appointed to take action upon the final report and 
publication of our drug proving by its director, Dr. Howard P. Bellows, 
submits the following: 

Resolved, That the work of drug proving which Dr. Howard P. Bel- 
lows has for six years been directing is of paramount importance. 

That his work has been of such an incessant .and laborious character 
as to demand more than passing notice. 

That it is bound to last forever, and must profoundly affect the whole 
science of medicine. 

That the thanks and appreciation of this society are hereby extended 
to Dr. Howard P. Bellows for his self-sacrificing, original and pains- 
taking care of the work done for and in the name of the O., O. L. 

Society. 

That these resolutions be spread upon the minutes and sent to the 

homeopathic journals for publication. C. Gurnee Fellows, 

Herbert D. Schenck, 
R. S. Copeland. 

On motion of W. R. King the above resolution was adopted unani- 
mously by a rising vote. ' 

THE DECEMBER MEETING. 

The last meeting was held at the Northwestern University Building 
Dec. 20th, 1906. The committee on society affiliation reported the re-, 
suits of its conferences. On the motion of Dr. Aurand seconded by 
Dr. Wilson " the executive officers of this society consisting of the presi- 
dent, secretary and treasurer, are empowered to make the necessary 
corrections in our constitution and confer and act in regard to the soci- 
ety affiliation." The question was discussed by Drs. Tenney, Hobson 
and McBean and was passed unanimously. The medico-legal committee 
requested the treasurer to forward a list of members whose dues are 
paid in full to date and who are entitled to the benefits of the medico- 
legal fund. The president called for the treasurer's report, which 
showed a nice balance in the treasury and a medico-legal fund of about 
$800. 

The nominations for membership included the names of Drs. F. A. 
Metcalf, L. C. Hatton, Annie H. White, and E. J. Abbott. These 
were given to the board of censors to be acted upon at the next meet- 
ing. The resolutions passed by the committees in joint session of the 
Chicago Homeopathic Society, the Clinical Society and the Englewood 



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THE CLINIQUE. 59 

Homeopathic Society recommending society affiliation were accepted 
by vote of this society. 

A resolution of thanks to Mr. Brundage, the County Commissioner, 
for his just appointments of Homeopathic Internes in Cook County 
Hospital was unanimously passed by the society after presentation by 
Dr. Wilson. The treasurer was instructed to pay out of the funds of 
the society the outstanding bills of the society for printing, addressing, 
stamps, rent, etc. 

The president appointed the Medico-Political committee of five mem- 
bers to consist of Drs. Shears, Kahlke, Hobson, Fitzpatrick and Cos- 
tain. Dr. Aurand made an earnest plea for the support by our society 
members of the Buffalo Rock Tent Colony for the treatment of tuber- 
culosis to be established at Ottawa, 111. Dr. Sarah Hobson and others 
also spoke for the project. 

The society then was entertained and instructed by an admirable il- 
lustrated address by Dr. W. Henry Wilson on "The cause, transmission 
and diagnosis of malarial fever." There was some discussion by Drs. 
Hingston, Hobson, Tenney, Banning and Wieland, and a vote of thanks 
was given to Dr. Wilson. The Stereopticon-Reflectoscope was loaned 
for the occasion by the Hahnemann Medical College. 

The meeting adjourned at 10:30 p. m. 

A larger attendance is urged at these meetings. 

Frank Wieland, Pres. 
George M. McBean, Secy. 



THE ROCK RIVER INSTITUTE MEETIITG. 

The 88th quarterly session of the Rock River Institute of home- 
opathy convened at the Gait House, Sterling, 111., Jan. 3, 1907. The 
meeting was called to order at 11:30 a. m., President E. A. Sickles, of 
Dixon, in the chair. In the absence of Dr. Blunt, Dr. B. L,. Sears, of 
Amboy, was appointed secretary pro tern. On roll call the following 
members responded: Drs. Sickles, Blackman, Sears, Kehr, Gordon, 
W. B. Carolus, Hill, Story, Hazelton, Gruber, Scott, Bushee, and Drs. 
Blunt and Maloney, later. Visitors. — Dr. Deyman, Dixon, 111.; Dr. 
Snavely, Sterling, 111.; Dr. Blackwood, Chicago. 

Minutes of previous meeting were read and approved. 

Moved and carried that the next meeting be held at Morrison, 111., 
April 4, 1907. The society then adjourned for dinner. On reconven- 
ing at 1:30 p. m. the name of J. L,. Snavely, of Sterling, graduate of 



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60 THE CLINIQUE. 

Hahnemann Medical College, Chicago, 1904, was proposed for member- 
ship and accepted. 

The following program was carried out: 

1. Schools and Methods and Principles of Homeopathy. — S. S. 
Kehr, M. D., Sterling, Ills. Discussion, L. H. Maloney, M. D., 
Savanna, Ills. 

2. A Metallic Circuit. — A. W. Blunt, M. D., Clinton, Iowa. Discus- 
sion, F. J. Scott, M. D., Rock Falls, Ills. 

3. Taking the Case. — O. B. Blackman, Dixon, 111. Discussion, F. 
W. Gordon, M. D., Sterling, Ills. 

4. My Method of Selecting the Remedy. — A. L. Blackwood, M. D., 
Chicago, IJls. Discussion, By Institute. 

All the papers called forth a lively and interesting discussion. Prof. 
Blackwood's presentation of his subject, was a masterly effort fully ap- 
preciated by those present, embodying and unfolding as it did, prin- 
ciples whose adoption by the profession at large, would redound to the 
success and power of the individual as well as the glory and permanence 
of homeopathy. More such papers read at our district societies would 
encourage their growth and influence in the community. 

Prof. Blackwood also spoke in behalf of the Homeopathic Tent Col- 
ony to be located at Buffalo Rock, Ills. His remarks were interesting 
and will no doubt bear the fruitage of substantial results. Society 
then adjourned. 

A pleasing aftermath of the meeting was a little surprise party for 
the Nestor of our society or F. W. Gordon, of Sterling, who has 
recently moved into his beautiful new home, a fitting reward of over 
forty years' practice in Sterling. 

The members of the society having taken Mrs. Gordon into their 
confidence, shipped a fine mahogany rocker into the home following it 
later in a body where they found the genial doctor, who had been 
called from the meeting to his office on urgent business totally unpre- 
pared for such an invasion. He accepted the situation however in his 
usual happy vein, but when the chair was presented by Dr. Kehr in 
behalf of the society, words were wanting to express his gratitude and 
appreciation. 

After a bountiful supper, prepared through the thoughtful kindness 
of the good wife, the evening was spent in a reminiscent mood. All 
present giving expression to their esteem for Dr. Gordon as they had 
known him, his unwearied faithfulness in behalf of the society and pro- 
fession, also his standing as "a man among men" representing the 
best and highest interests of the community in which he had lived and 
labored so long. B. L. Sears, M. D., 

E. A. Sickkls, M. D., President. Sec'y Pro Tern. 



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THE CLINIQUE. 61 

TUBERCULOSIS TENT COLONY. 

To the Members of The Illinois Homeopathic Medical Association: 

The tuberculosis Tent Colony Committee report that in spite of the 
repeated notices given to the profession and to the personal solicitation 
on the part of the members of the committee there has been no enthu- 
siasm demonstrated by the profession in helping to launch the tent 
colony. 

.The first payment on the land has been made; the final payment is 
due this month and must be met or the first payment amounting to 
$1000.00 will be forfeited. To meet this condition a few men have 
clubbed together and have underwritten the balance due on the con- 
tract. The contract will be purchased by this group, the stock placed 
among their personal friends and the project of incorporating and oper- 
ating the Buffalo Rock Tent Colony will be assumed by them together 
with those who have already subscribed for stock. 

In this way the interests of the State Association and of the early sub- 
scribers will be protected. The purpose of having in Illinois an open 
air colony under the immediate care of members of the Homeopathic 
profession will also be assured. It is to be hoped that the institution 
will receive more enthusiastic support after it is established than it has 
during its period of inception. 

Until January 25th, 1907, subscriptions from the profession will be 
received, a limited amount of stock being reserved to meet any further 
requests on the part of the profession. 

Further information in reference to any part of the work connected 
with the purchase of the property and the method of organization can 
be obtained from any of the undersigned. 

Jos. P. Cobb, M. D. 
A. E. Smith, M. D. 
S. H. Aurand, M. D. 
A. L. Blackwood, M. D. 



A LARGE GIFT TO OLD HAHNEMANN. 

By the will of the late Daniel B. Shiptnan, the Hahnemann Hos- 
pital of the City of Chicago has been given what is believed will 
amount to more than a quarter of a million dollars. According to Mr. 
Shipman's will, his estate, the value of which is placed at $1,400,000 is 
divided among five Charities of the City of Chicago. " Share and share 
alike." 



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62 THE CLINIQUE. 

The money is to be held as an endowment, the proceeds to be used 
for the benefit of said hospital. This with the endowment already in the 
possession of the hospital places the institution in a very favorable posi- 
tion. Incidently it may also be said that inasmuch as the hospital and 
the college have always worked in harmony, that this endowment is a 
great benefit to the college as well. The institutions combined now 
represent about three-quarters of a million capital. 



fl}00k getrieurs. 



Surgery: Its Principles and Practice. In five volumes. By 66 
eminent surgeons. Edited by W. W. Keen, M. D., L. L. D., Hon. 
F. R. C. S., Eng. and Edin., Professor of the Principles of Surgery 
and of Clinical Surgery, Jefferson Medical College, Phila. Vol. 1: 
Octavo of 983 pages, with 261 text-illustrations and 17 colored plates. 
Philadelphia and London. W. B. Saunders Company, 1906. Per 
volume: Cloth, $7.00 net; Half Morocco, $8.00 net. 

This volume is very attractive in its workmanship, while the contents 
embrace some subjects not usually presented in works on surgery that 
greatly increase its value. Among the chapters worthy of special men- 
tion are Narrative of Surgery: A Historical Sketch, Surgical Physiology, 
Examination of the Blood, and Infection and Immunity. The Editor of 
this surgery, Dr. W. W. Keen, is eminent in the surgical world, and his 
collaborators are hardly less so, among them being Drs. Adami, Bland- 
Sutton, Crile, Hektoen, Mumford, and Wood. As contributors to the 
entire work (five volumes) may be noted the names of the great 
American and European surgeons, thus insuring a surgical work which 
fills a decided want. Among other valuable features are to be noted 
the splendid illustrations and a very full bibliography pertaining to the 
subject-matter of each chapter. V. R. 



Diet in Health and Disease. By Julius Friedenwald, M. D., Clin- 
ical Professor of Diseases of the Stomach in the College of Phy- 
sicians and Surgeons, Baltimore; and John Ruhrah, M. D., Clinical 
Professor of Diseases of Children in the College of Physicians and 
Surgeons, Baltimore. Second Revised Edition. Octavo of 728 pages. 
Philadelphia and London: W. B. Saunders Company, 1906. Cloth, 
$4.00 net;* Half Morocco, $5.00 net. W. B. Saunders Company, 
Philadelphia and London. 

This book of 800 pages is by a well known author and teacher and 



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THE CLINIQUE. 63 

its popularity is evinced by the fact that this is the second and thoroughly 
revised edition. The book is valuable not alone because it takes up 
completely the chemistry and physiology of digestion, but because it 
carefully considers the indicated diet in different diseases. It is not so 
verbose that the everyday practician cannot get the points he wants in 
a hurry; in this respect it is the best work of the kind we have yet seen. 
The chemical composition of American food materials are completely 
given in the last part of the book. We gladly recommend it. 



A Text- Book on the Practice of Gynecology. For Practition- 
ers and Students. By W. Easterly Ashton, M. D., LL. D., Professor 
of Gynecology in the Medico-Chirurgical College of Philadelphia. 
Third edition, thoroughly revised. Octavo of 1096 pages, with 1057 
original line drawings. Philadelphia and London: W. B. Saunders 
Company, 1906. Cloth, $6.50 net; Half Morocco, $7.50 net. 

This is the third edition called for within one year after the original 
publication and to quote the author, " represents my views at the pres- 
ent time, based upon an actual working knowledge of the advances that 
have been made in gynecology and abdominal surgery." It well illus- 
trates the fact that any specialty dovetails into many other specialties, 
as evidenced by the chapters on The Blood in Relation to Surgery, 
Constipation, Intestinal Anastomosis, Passive Incontinence of Urine, Ap- 
pendicitis, etc. This book merits a place in the library of any practi- 
tioner who wishes to keep in touch with progressive gynecology. 

V. R. 



A Text-Book of Obstetrics. By Barton Cooke Hirst, M. D., 
Professor of Obestetrics in the University of Pennsylvania. Fifth 
revised edition. Octavo of 915 pages, with 753 illustrations, 39 of 
them in colors. Philadelphia and London: W. B. Saunders Company, 
1906. Cloth, $5.00 net; Half Morocco, $6.00 net. 

When a book has reached its fifth edition, it usually means that it con- 
tains much that is worth having. One needs but to briefly run through 
this volume to realize that it is full of practical up-to-date information 
gathered at first hand in a long practice of this specialty. Since there 
are today many books written about the various branches of the medical 
art, it is sometimes difficult to decide which book one should purchase. 
And the facts which aid in a decision are the prominence of the author 
and his breadth of experience. This volume appeals to one because of 
.its handiness, the ease with which one can find what he is looking for, 
sits many fine illustrations and its originalities. V. R. 



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64 THE CLINIQUE. 

The Practitioners' Visiting List for 1907. A valuable pocket-sized 
book containing memoranda and data important for every physician, 
and ruled blanks for recording every detail of practice. The Weekly, 
Monthly and 30-Patient Perpetual contains 32 pages of data and 160 
pages of classified blanks. The 60-Patient Perpetual consists of 256 
pages of blanks alone. Each in one wallet-shaped book, bound in 
flexible leather, with flap and pocket, pencil and rubber, and calendar 
for two years. Price by mail, postpaid, to any address, $1.25. Thumb- 
letter index, 25 cents extra. Descriptive circular showing the several 
styles sent on request. Lea Brothers & Co., Publishers, Philadel- 
phia and New York, 1906. 



NEW5 ITEMS. 

Dr. C. E. Kahlke announces that his hours at 100 State St., are from 
10:30 to 12:30, instead of from 1 to 3 p. m., as formerly. 

The Ustion Fraternity gave a dance to the Alumni Friday evening, 
Dec. 7, '06, at Abraham Lincoln Center Hall. A fine time is reported. 

Dr. J. H. Wood, San Francisco, has removed to the Morson, 1386 
Sutter St. 

Married — Dr. Eugene H. Eastman and Miss Leona Anderson Sny- 
der, December 26th, 1906, at Dayton, O. At home after January 15, 
'07, at Hot Springs, Ark. 

Telephone Concessions to Chicago Physicians. — President Hibbard 
of the Chicago Telephone Company stated to a committee representing 
the Chicago Medicaf, the Chicago Homeopathic, Eclectic and Dental 
Societies, that he would consent to the following telephone concessions: 

1. Plugs to the number of three, paying $10.00 for each installment 
and no rental. 

2. Allow M. D. after the names in the directory on two-party lines. 

3. Would not object to the publishers of the telephone directory put- 
ting the names of physiciaus on both the classified and general lists. 

4. Extensions to the number of three, to cost $6.00 each annually, 
without charge for installation. 

5. The company would not object to physicians paying three cents 
for each call at drug-stores upon presentation of proper identification 
cards. This has also been accepted by the Retail Druggists Association. 

Inasmuch as the Chicago physicians pay more in proportion than 
any other class of telephone users, it is urged that they use all their in- 
fluence to obtain further concessions in the new ordinance now pending 
in the city council. 

G. M. McBeax, Secy. Chicago Homeopathic Medical Society. 



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THE CLINIQUE. 



VOL. XXVIII. FEBRUARY, 1907. NO. 2 



Original ^vticlzs. 



PUERPERAL FEVER. 

GEO. H. RIPLEY M. D., KENOSHA, WIS. 

In preparing a paper on puerperal fever, I realize that I am going 
over ground that has been covered many times. Puerperal fever has 
existed, no man knows how long. Probably as long as babies have 
been born and microbes around the earth, Galen and Hippocrates re- 
ferred to it though not under the same name. In a treatise by Mr. 
Hay, member of the Royal College of Surgeons of London, he describes 
an epidemic of puerperal fever at a time when it was very little under- 
stood. At that time it was not known how it spread, and its ravages 
were unchecked by art. The epidemic was allowed to run its course 
unhampered by asepsis or antisepsis, and one wonders that it ever 
ceased. Here is shown a possibility as to our present theories not being 
wholly right. We may have something of the natural history of mi- 
cro-organisms to learn. We need to learn how they lose their viru- 
lence as well as acquire it; how they sometimes find a soil in which they 
develop without limit, and how they find conditiQns that resist them. 

The same writer describes an epidemic which began in 1809, and 
continued in diiferent degrees of severity till 1812. It was not confined 
to town, but in the country and to towns adjacent so that the cause and 
means of propagation were not local. It developed under varying cir- 
cumstances. No class seemed to be immune, the epidemic starting 
amongst the better class and extending to all conditions, the robust as 
well as weakly, old or young, and those who had easy labors as well as 
the difficult ones. Many were ill from it whose situation and circum- 
stances should have exempted them from it. Here is a significant point. 
He says, "During this epidemic of puerperal fever, erysipelatous in- 
flammations prevailed and in many cases, were of a malignant type; 
the most severe I have ever seen." 



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66 THE CLINIQUE. 

This was noticed in other epidemics, that the two diseases, puerperal 
fever and erysipelas, kept pace with each other, reaching their acme 
together and ceasing together. In those days nurses and midwives 
went from case to case with a recklessness excusable only by ignorance, 
and of course carried the infection. Mr. Hay says further that he did 
not express a definite opinion as to the infectious nature of the disease. 
" It was my invariable custom to use such precaution in my attendance 
on patients as to preclude any possibility of conveying infection to 
them. It was an invariable rule never to attend a patient in child-bed 
in any article of clothing which had been in the presence of one affect- 
ed with puerperal fever, without washing such parts of my person as 
had been exposed in any way to infection." He said that he believed 
that if anyone would practice these precautions, they could go from one 
case to the other safely, even though it was as infectious as some were 
claiming it was. It was not till the discovery of the germ cause of 
disease and the principle of sepsis and antisepsis that any advance was 
made in the treatment of it. Until its cause was known, more child- 
bearing women lost their lives by it than all other diseases peculiar to 
their sex combined. 

My intention is to summarize the present status of puerporal fever, 
drawing largely on the magazine articles, adding what I can from 
personal observation. For a thorough study of this condition we mnst 
depend on those who have a large obstetrical practice, or have the bene- 
fit of a free hospital or lying-in institution. I believe most of the statis- 
tics we get are from such institutions. As in most things medical, 
there is considerable chaos. Some writers come to conclusions almost 
opposite to what others working along the same lines do. We must 
take it all, and hold what seems good. 

It is generally conceded that the streptococci are the important micro- 
organisms in puerperal infection, both from a numerical point of view 
and with regard to mortality. The staphylococcus pyogenes aureus and 
albus are frequently found, but the cases in which they only are pres- 
ent are not as virulent and respond to treatment more readily. A spe- 
cies of diphtheroid bacillus has been found within the uterus, but is 
more commonly found in abrasions of the external parts. I recall a 
case in which fever occurred on the second day. Examination showed 
a true diphtheritic membrane in a small tear at the fourchette. The 
fever ran the usual course of diphtheria, and there was a severe case of 
neuritis and paralysis of the lower limbs as sequelae. The patient made 
a complete recovery. I found there had been a case of diphtheria in 
the house some time previous to the confinement. 



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THE CLINIQUE. 67 

The baccillus coli communis is frequently found. Cases infected by 
it are not of the severe type, and respond to antiseptic treatment. They 
are found in all cases where rupture into the rectum has occurred and 
are very apt to appear late in all cases. The gonococcus, while causing 
a fever if present in numbers, does not cause as serious results unless 
abscesses form in the broad ligaments or such conditions, having ex- 
isted previous to labor, which rupture and cause infection of the periton- 
eum. There is a difference of opinion as to the source of infection. 
Some writers claim that there can be no pathogenic organisms in the 
healthy woman's tissues, nor are they found in the healthy genital 
tract above the level of the hymen and external genitals. The fact 
that babes delivered by Caesarian section have developed gonorrheal 
ophthalmia as well as those delivered in the natural way, shows that 
there may be infection even though the genital tract be made sterile 
and kept so. 

These cases are not common, and we must put the major portion of 
the responsibility on the accoucheur. That his patient is not clean and 
surroundings unfavorable, should only make him redouble his preven- 
tive efforts. One writer says no digital or vaginal examination is nec- 
essary. That a physician should be able to diagnose position and pre- 
sentation by external touch. This would be too uncertain for the gen- 
eral practician. He does not attend cases enough to become sufficiently 
expert, and would not be safe-guarding his patient unless sure the child 
was entering the pelvis in the proper position. Hart of Edinburg tells 
of carrying out this plan safely in hospital work for two months, but 
the first case examined internally had prolapse of the funis. The 
child's life would have been endangered had no examination been made. 

The examination through the vagina can be made safely if properly 
conducted. When possible have the patient thoroughly bathed, and 
the vulva cleaned by running water. With a clean pad on the bed and 
the patient dressed in clean linen, one source of danger is removed. A 
thorough cleansing of the hands in running water, or water that has 
been boiled, with soap and brush is imperative. The nails should be 
cleaned carefully, using five to ten minutes for the hand toilet. If 
there is any suspicion that the hands cannot be made thoroughly 
aseptic, or if the physician has been in any way connected with a sep- 
tic case, the rubber gloves must be used. Boil them and prepare hands 
the same as before. A little practice makes the touch almost as ac- 
curate as the bare hand. The first examination is important. Take 
time and make it thorough. Satisfy yourself as to position and pre- 
sentation, and the comparative size of the forthcoming head and the 



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68 THE CLINIQUE. 

parturient canal. After this first / examination the character of the 
pain, and the condition of the soft parts determined by inspection, will 
be sufficient guide to further interference. 

Many of the writers agree that there are two forms of puerperal fever; 
the one an autoinfection, the other an infection from without. The 
first, or auto-infection, is said to come from absorption of decomposing 
animal tissue, usually pieces of the placenta or blood clots, commonly 
called sapremia. The other, or septicemia, due to external infection, 
either by the attending physican or nurse, or from the patient herself. 
One writer claims tjiat one form is due to infection through the veins, 
and the other through the lymphatics, and that there is no difference in 
the source of the infection. I have learned by experience that some cases 
are much more virulent than others, that some respond to a thorough 
cleansing of the parturian canal, while others do not; and am inclined 
to believe that some forms of infection are more active than others. 
Again I can recall two instances where the infection appeared to come 
from a common source*, that one patient was severely infected and the 
other mildly. There are a number of methods of invasion. The trau- 
matism to the external parts especially in the primipara is usually 
severe. There is more or less abrasion and nearly always some Assur- 
ing of the skin and mucous membrane besides the cervix o£ uterus. 
These become infected by septic hands on the part of the attendant or 
unclean bedding or napkins. 

In severe labors there may be traumatism enough to cause necrosis 
of some of the tissues and gangrene develop. Hospital gangrene and 
spreading traumatic gaugrene are not seen as frequently as they form- 
erly were. This may occur at any point in the parturient canal, and 
be difficult of detection. In sapremia the trouble is supposedly caused 
by debris. Some part of the placenta or membranes were not removed 
at the time of the labor. The abraded surfaces absorb the toxins, and 
fever results. Sapremia is not caused by microbes in the blood, but by 
toxins produced by these microbes. They are organisms which feed 
on dead tissues, but not upon living tissues, and may grow in lochia or 
retained membranes. This is a chemical poison, and the effect is in 
proportion to the dose. The symptoms cease when the poison has been 
removed. Septicemia is the severe form. The septic material is foreign 
matter introduced during labor. Either by the examining finger, the 
careless nurse, or unclean instruments or clothing and bedding. The 
smallest break of the skin or mucous surface is sufficient for its en- 
trance, hence easy labors are liable to it. The symptoms are severe 
from the first. 



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THE CLINIQUE. 69 

Puerperal peritonitis fortunately is not; common. It may be the re- 
sult of direct injury to the peritoneum during labor, or of septic mate- 
rial escaping from the uterus through the fallopian tubes, or to rupture 
of pre-existing pyosalpinx. This form of peritonitis should be distin- 
guished from that which occurs late in septicemia. It begins early in 
the puerperium, and is extremely fatal. All conditions where fever is 
present during the few days following a confinement are not septic. 
There are fevers which may come the first, second, third, or any day 
soon after labor is over that will cause the attending physician any 
amount of anxiety, that cleat* up and no complications result. I recall 
a case where the temperature was 104° the next day after an easy labor. 
I could see no cause for it. The fever was entirely gone the next day, 
and the patient made an uneventful recovery. 

No careful physician can attend a confinement and not be anxious 
about his patient until the eventful third day is passed. If, during the 
first four days, fever develops, he muht determine at once the cause. 
I know of no other condition in which it is more necessary to make a 
diagnosis early and act promptly. Any rise of temperature above 100° 
during the second or third day after delivery is dangerous. If preceded 
by a chill it means septic absorption. There will, be no trouble in di- 
agnosing a typical case. The severity of the onset indicates the viru- 
lence of the poison. A thorough examination of the pelvic organs 
should be made under careful antiseptic precautions. Bear in mind 
that there is always some tenderness about the vagina and cervix after 
labor. The sensitiveness, if absorbtion of septic material has taken 
place, is at the sides of the uterus in the broad ligament and tubes 
as well as the uterus. Notice the odor from the discharge and the 
character of the debris. If convenient have a culture made at once, 
and determine by the microscope what form of bacteria is present. 
This is especially necessary if the serum treatment is used. Make a 
visual examination of the external parts, and notice the condition of 
any abrasions that may be seen. 

The main point to determine first is the type of fever we have to 
deal with. Whether we have an absorption of decomposing animal 
matter, or whether the poison is from without. If a microscopical 
laboratory is convenient, one may be greatly aided by having a culture 
made. A thorough cleansing of the parturient canal should be done at 
once. If relief is obtained, if the temperature drops to normal, or 
nearly so, and symptoms abate, the diagnosis is clear. On the other 
hand, if the patient is worse, and the chill and fever continue or in- 
crease, the more virulent form of fever is present. The nervous and 



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70 THE CLINIQUE. 

anxious condition of the patient will aid in confirming the disgnosis. 
Greater difficulty is experienced in making a diagnosis if called after 
the patient has been ill several days. Probably a midwife has been in 
attendance, and will try to conceal the condition if sufficiently intelli- 
gent to suspect what trouble is present. If the disease has progressed 
so far, abscess may be formed and must be recognized. Repeated 
chills with localized tenderness and tumefaction in a septic case makes 
the diagnosis almost certain. 

The chill and fever that come with mastitis, simulates puerperal 
fever. There are the same nervous symptoms, restlessness, thirst, 
aching in muscles, but mastitis is apt to come later, not often before the 
second week; although I saw one patient where there were two attacks, 
accompanied by the chill and rise of temperature during the first week. 
The localized pain in the breast aids in the diagnosis. I can recall a 
case in which there was a twin birth at the eighth month of pregnancy; 
the amniotic fluid was excessive. Thirty-six hours after the confine- 
ment, the patient had a hard chill, followed by a temperature of 104. - 
I used a thorough douche, both vaginal and intrauterine. The follow- 
ing morning the temperature was normal and at 11 a. m. the fever and 
chill were repeated. I repeated the treatment and found the temper- 
ature normal in the morning again. When, for the third time, at the 
same hour, the chill and fever returned, I thought I saw a good indi- 
cation for some quinine, a few doses of which cleared the case up with 
no further trouble. 

Having decided that you have a case of sepsis to treat, the first con- 
sideration is local disinfection. This should be done at the earliest 
moment before absorption has taken place, or the microbes penetrated 
too deep to overtake. If the symptoms are suspicious and cannot be 
accounted for by any other condition, active treatment should be insti- 
tuted at once. Make a careful examination, noting the condition of 
any abrasions or laceration. If repair work has been done and is not 
in a healthy condition, remove the stitches, and after thoroughly cleans- 
ing, swab with tincture of iodine or pure carbolic acid. If such wounds 
are covered with a false membrane it indicates a severe infection. This 
used to be seen during epidemics or puerperal fever more than since 
antiseptic midwifery is practiced. If possible secure a specimen of the 
secretion from the uterine cavity for microscopical examination and cul- 
ture, the result of which will aid greatly in the treatment and progno- 
sis. If only saphrophytic microbes are present, the thorough evacua- 
tion of the uterus will allay the symptoms and the prognosis will be favor- 
able. If septic microbes and streptococci are present, the prognosis is 



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THE CLINIQUE. 71 

more grave. If the uterine discharge is offensive it is more apt to be 
sapremic. In the virulent form it may be quite free from odor, and 
irrigation does very little good. If the accoucheur is careful when the 
placenta is delivered to inspect it carefully, he may know positively 
whether retained membranes are causing the trouble. If the placenta 
does not come away intact, there is more reason ,to suspect retention. 

If the fever is moderate, not over 102, all that may be necessary is 
to give the uterus a thorough washing out. Use a tube that allows a 
free return of the water and not liable to clog up with clots. Use a 
non -poisonous solution, such as lysol 1 % or creolin. If the bichloride 
of mercury is used, follow with sterile water or normal salt solution, 
and in all cases allow the uterus to drain out before removing the tube. 
In giving the douche, allow the water to start to flow before the douche 
tube enters the vulva, and wash the vagina before washing the uterus. 
While the tube is in situ, move it gently from side to side, thus coming 
in contact with the surfaces of the womb. Use a large quantity of 
water, and have it at about 110°F. Let it flow until it returns clear 
and examine the debris washed away to determine if the douche has 
brought away anything that might have been causing the trouble. If 
the bowels are not moving freely give some active cathartic and clear 
them out. 

If in twelve hours the fever has not abated, the uterus should be 
explored, or if in the beginning of the fever it is 103 or more, give an 
anesthetic and make a thorough digital exploration to determine if there 
is any debris retained in the uterus. There may be adherent particles 
that are not washed out by the douche. If so detach them with the 
finger if possible, if not use the dull or spoon curette aiming to not in- 
jure the uterine surface. Curetting, unless done with extreme care 
may be injurious, breaking down the barrier that nature has thrown 
out in the way of inflammation to limit the spread of the microbes. 
Some advocate the curetting away of the whole mucous surface of the 
womb, hoping to bring away all of the diseased tissue. I believe this 
to be impossible, and it surely leaves a large surface exposed to fresh 
infection. If this work has been carefully and thoroughly done and 
there is no marked abatement of the symptoms, the microbes have spread 
to the appendages and probably the blood is infected. If the symptoms 
do abate and there is evidence that the infection has been checked, the 
irrigation Should be repeated once or twice daily till the offensive odor 
is gone and temperature becomes normal and remains so. If the more 
virulent type of fever is present the fight is on, and your skill and the 
patient's vitality will be pitted against a foe that knows no sleep and 
thrives on activity. 



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72 THE CLINIQUE-. 

The patient must be fed liberally by an abundance of liquid diet. 
Give something every two hours except when asleep. Give plenty of 
water, thereby helping to flush as much of the poison out through the 
kidneys as possible, milk in any form, perfectly fresh, unsterilized if 
possible. Milk diluted with oatmeal water or barley water, malted 
milk, junket, or butter milk will suffice. I believe if alcoholic stimu- 
lants are ever useful in disease, this is their place. The length of the 
illness makes them undesirable, as after a time they lose their efficacy 
and the reaction may be disastrous to the patient. Normal salt solu- 
tion injected into the cellular tissue or directly into the vein should be 
used. The use of medicine is of less importance than the maintenance 
of the strength by proper nourishment. No drug should be given that 
disturbs the stomach, and thereby interferes with the ability to take 
food. To control the fever if excessive, cool applications to the head 
and skin surface is most effective. Cool sponging, the rubber bag 
filled with cold water on the head will be well borne. 

The homeopathic remedies often give relief from the high temper- 
ature, but do not control it in all cases any more than any other inter- 
nal remedies. Gelsemiuin, arsenic, veratrum viride, ecchinacea, bap- 
tisia, terebinth, cantharis, and others may be indicated and should be 
prescribed as symptoms indicating them develop. The old school 
depends on quinine given in large doses, often to the limit of toler- 
ance. The popular antipyretics are dangerous because of their de- 
pressing action on the heart. Medicine that irritates the stomach 
should be avoided as the patient's recovery depends more on keeping 
the digestive function in good condition than on medicine. For the 
pain morphine may be given, and if there is intestinal paralysis, atro- 
pine should be used with it. Morphine may be used freely when that 
condition arrives when the only hope is to relieve the suffering, especi- 
ally when there is extreme bowel distention. 

The use of antistreptococcic serum is not yet out of the experimental 
stage, or if it is, is not a success. It appears that the different cultures 
vary so much, that a serum made from one does not affect the other. 
Efforts have been made to produce a mixed serum by treating horses 
by successive cultures derived from different sources. Investigation 
along this line is being carried on, which, no doubt, will give good re- 
sults. The antistreptococcin is supposed to have a bactericidal action, 
differing in this respect from diphtheria serum, which has only antitox- 
ic. It cannot, therefore, be expected to act effectively when the strep- 
tococci are multiplying outside of the tissue as in the peritoneal cavity, 
hence is more likely to be of service if used early in the infection. It 



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THE CLINIQUE. 73 

should be used as soon as the case is diagnosed, especially in the severe 
forms and given freely. There are no serious after effects, a moderate 
erythema being the principal one. Most physicians, being unfamiliar 
with it, give too small doses, fearing the effect may be unfavorable. 
20 cc at the first dose, and that much or more giving from 40 to 60 cc 
in the 24 hours. Tasel, a German writer, says, give 100 cc to 200 cc 
in 24 hours. Penham gives 100 cc at a dose. 

There seems to be a good deal of uncertainty abont the part that 
microbes take in the production of puerperal fever. The labors of a 
number of investigators show that in the greater part of those who die 
of puerperal sepsis, streptococci are found in the blood and internal or- 
gans. Others have seemed to prove their presence in the vagina dur- 
ing pregnancy and also in the vagina and uterus post partum in ' 
women who subsequently made normal convalescences; some prac- 
ticians have reported a series of cultures from uteri of recently deliv- 
ered women in which streptococci were found. Judging from these re- 
sults, we are dealing either with an organism of varying virulence or 
different varieties of the same organism, and that the same organism 
will have different effect under different conditions. In a general way 
we may say that the results in any case depend on the general health 
and susceptibility of the individual, the condition of the tissues exposed 
to the infection, and the virulence of the organism, and headway made 
before treatment is instituted. 

One writer claims that he demonstrated that the serum of an animal, 
immunized by a certain strain of streptococci, protected only against 
that particular strain, and had little or no influence on others. He also 
showed that it was possible to inoculate with two varieties and obtain a 
serum, that was potent against both. Others claim that serum from 
animals would not have an effect on man, and that the organisms un- 
dergo a change in passing through the living body, sometimes being 
more and at others less virulent, so that the virulent form in man may 
produce no reaction in the animal and vice versa. He concludes that 
the principal reason for the dissimilarity of results in the two diseases, 
speaking in regard to diphtheria and puerperal fever, that in diphtheria 
we are dealing with a local process needing an antitoxine, and in puer- 
peral fever with many strains of the same organism requiring a polyva- 
lent anti bacterial and anti toxic serum. As yet we have nothing ful- 
filling these requirements, for all serum so far are only moderately poly- 
valent and possess little or no antitoxin, hence if one serum kills the 
particular strain of organism, it has no effect on the toxin already liber- 
ated. This is left for the individual to overcome if able. 



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74 THE CLINIQUE. 

Bumm, writing in one of the Berlin medical journals, summarizes the 
present status of the treatment of puerperal fever by the application of 
serum as follows: "There exists today no serum which exerts any clin* 
ically proven influence upon the pathological tissues, which is the re- 
sult of the spread of the streptococci from its original point of entrance. 
The employment of antistreptococcic serum when a general peritonitis 
of puerperal origin, a pyemia, a parametric phlegmon etc., exists is- 
ineffectual and useless.' ' He believes, undoubtedly, whenever this or- 
ganism has not extended beyond the endometrium, or is circulating in 
the blood stream without metastatic lesions, the serum aids in overcom- 
ing the infection; that after severe operations and foul uterine discharges 
its prophylactic use is to be recommended; that large doses are neces- 
sary, repeated every two or three days; that the earlier it is injected the- 
better the results. This seems a fair statement of what we may expect 
today from the serum treatment of the streptococci in puerperal fever. 

The treatment of the chronic form of puerperal fever depends on the 
conditions present. Abscesses should be evacuated and drained as soon 
as located. Hilton's method is to make an incision through the skin or 
mucous membrane, and a director or sinus forcep is pushed on till pus 
flows. Then the blades of forceps are opened wide enough to admit 
the finger. The drainage tube should have a flange to hold it in posi- 
tion and be lined with a glass tube in the upper part to prevent collapse. 
Hysterectomy has been advocated by some as a logical cure if done in 
the early stage. Many cases get well without this mutilation, and by 
the time the case has (developed to the point where hysterectomy seems 
necessary, the infection has spread beyond the uterus. The mortality 
in hysterectomy cases is too high to warrant its indiscriminate use. In 
pelvic cases the removal of the uterus allows of ideal drainage. It may 
be advisable in some exceptional cases, such as abscess of the uterine 
wall or sloughing myoma. At the outset of peritonitis some advocate 
the thorough curettage of the uterus and packing with iodoform gauze, 
then opening the vagina in Douglas pouch and packing it with iodo- 
form gauze. This has been practiced by Pryor with good results. 
Abdominal incision is indicated only where there is reason to suspect a 
ruptured pyosalpinx or an existing one by a tumor at the side of the 
uterus. If due to gonorrheic infection, the result is more hopeful; if 
streptococcic, the safer method is to evacuate through the vagina. In 
general diffuse peritonitis abdominal section affords very little hope. 
A thorongh flushing with normal salt solution and drainage by pack- 
ing iodoform gauze in the pelvis, and a large drain in Douglas pouch. 

To summarize. Prevent puerperal fever by being very careful of 



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THE CLINIQ'UE. 75 

every case during the confinement. Insist on cleanliness on the part 
of the patient and everything connected with her. Be thorough with 
the hand toilet, and always carry a pair of sterile rubber gloves in ob- 
stetrical bag to be used if a hurried examination is to be made, or if 
attending a septic case at the same time. If fever develops act prompt- 
ly night or day. Empty the uterus and cleanse thoroughly, and give 
the antistreptococcus serum in large doses. If the virulent form de- 
velops, clean and pack the aiterus and open Douglas pouch and pack 
with iodoform. Keep up nourishment and stimulants if needed, and 
trust to the vitality of your patient to pull her through. Be on the alert 
for complications. Do everything that may be for your patient's bene- 
fit, but be careful not to do too much. She must be allowed to rest 
naturally if she can, with soporifics, if necessary. Make every eifort to 
save your patient, and you will be rewarded by her recovery, if she re- 
covers, and if not, the feeling that you have done your best is some re- 
muneration. 



SEPSIS VERSUS ASEPSIS IN A GENERAL OBSTETRICAL 

PRACTICE. 

W. B. WEBB, M. D., BEAVER DAM, WISCONSIN. 

The old proverb, "An ounce of prevention is worth a pound or cure," 
is no where more trite, true and to the point than when applied to puer- 
peral sepsis. There is nothing, I imagine, which will create more 
alarm in the lying-in room than a diagnosis of puerperal infection, if the 
condition is described by that dread term, " blood poison." Even the 
most ignorant and the dirtiest of our patients understand much of the 
meaning of this term, and their understanding inspires a feeling of su- 
perstitious horror when, with the advent of the first child, a suspicion 
of the trouble is aroused. 

Even the doctor who regards the germ theory as a myth and who 
would relegate the scrubbing brush and all antiseptic precautions to 
oblivion were it not for the influence which they have on the family, 
friends and neighbors and because professional acquaintances and com- 
petitors use them, feels his blood run cold when he realizes that his 
patient has been infected and is doomed to pay the penalty of someone's 
carelessness. If every doctor understood the principles of asepsis as 
thoroughly as he ought, and was as conscientious as he ought to be in 
♦Read before Wisconsin State Homeopathic Society. 



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76 THE CLINIQUE. 

carrying out the details of an aseptic propaganda, the mortality rate in 
obstetrical practice would certainly be reduced and the morbidity rec- 
ords would likewise be diminished, but puerperal sepsis would not 
thereby be entirely blotted out. Many reasons for this are apparent. 
There may be germs of infective disease lying latent in the parturient 
canal which cannot be destroyed by the most faithful antepartum 
douching. An old salpingitis which may have partly ceased from 
troubling, is likely to be roused into fresh activity by the parturient 
crisis. Fever, chills and a diagnosis of infection results. Every or- 
der which the doctor has given to patient, nurse and attendants, may 
have been disregarded, to the detriment of both doctor and patient. 
Every effort which the doctor has made, personally, for the patient's 
safety and well-being, may have been neutralized or rendered ineffective 
by reason of criminal carelessness on the part of someone in the lying- 
in room. 

One source of infection, and a not infrequent one, is the medical at- 
tendant himself. There are many ways in which the doctor may be 
the means of carrying infection to his lying-in patient. Carelessness 
in the matter of scrubbing his hands, inattention to finger nails which 
are more dirty than they look, and clothes which have been worn while 
attending cases of infective and contagious disease. I knew a physician 
very well, a few years ago, who had at one time several cases of puer- 
peral infection on hand. In the course of a few months, that man had 
at least 7 or 8 cases of puerperal sepsis to deal with. I was called to 
see some of the cases with him, and had a frank talk with him about 
his troubles. This man had a discharging fistula, the result of an un- 
successful operation which had been done years before on an inguinal 
hernia. I urged him to take no more confinement cases so long as he 
was suffering from this pus discharge. I heard a very good doctor say 
in a medical meeting that he never had any bad luck with his confine- 
ment cases after he was cured of a purulent discharge from one of his 
ears. If a doctor suffers from ozena, a weeping eczema, localized or gen- 
eral, or any chronic discharge, he is unfitted to do obstetrical work. 
The doctor, however, is not by any means, the only source of germ 
conveyance in cases of puerperal sepsis, but he is most certain to get the 
credit for having done the mischief if a case of sepsis, or childbed fever 
occurs in his bailiwick. In the avoidance of sepsis in an obstetrical 
case, if the parturient canal can be rendered aseptic and maintained in 
this aseptic condition, our patient will be absolutely safe unless there 
be some infective disease of the appendages which breaks out and 
makes trouble. This model condition of the parturient canal can only 



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THE CLINIQUE. 77 

be maintained by careful attention to absolute cleanliness, which neces- 
sitates personal care on the part of the doctor, the nurse, the patient 
herself, and all attendants. 

The doctor who intends practicing midwifery should make a careful 
study of all the means to be employed in the prevention of sepsis. If 
he is in attendance upon a case of infective disease, such as diphtheria, 
erysipelas, or any pus case where the hands must of necessity become 
infected, the only safe thing to do is to refuse all obstetrical calls. To 
do this, means much to the doctdr. I have done it many times and 
more than once to my surprise and consternation, have found that I 
had given offense to and had been cast off by the very people with 
whom I was endeavoring to deal fairly. If we must attend a confine- 
ment case while having in charge a case of infective nature, it is 
absolutely necessary that we take a thorough bath before going to the 
patient, and make a complete change of clothing. Under such circum- 
stances, lysol would be a good substitute for soap when taking the bath, 
in rendering ourselves u surgically clean." The care of the hands is 
too often the first and chief care. This may seem perfectly natural, 
but it is vitally important that our bodies, our hair, and our clothing 
be clean even if not surgically aseptic, and that we be covered with a 
clean sheet or gown while in attendance at the obstetrical bedside. We 
all use the scrubbing brush, but whether it is used as much, as often, 
and as thoroughly as it should be is a question. The conditions of the 
brush, as well as the wash bowls, towels, and all utensils used should 
not be forgotten. The scrubbing brush is a delusion and a snare if it 
is not kept clean. I know a physician who, if he were going to ampu- 
tate the great toe of a 16-year old boy, would scrub, boil, and asepticize, 
but if he were to deliver that 16-year old boy's mother of a pair of 
twins, would be content to dip his fingers two or three times in a little 
carbolic acid solution and call that asepsis. The wearing of rubber 
gloves as is done by many of our up to date obstetricians is a safeguard 
against germs which cannot obtain if the uncovered fingers are used. 

The directions, given us by our obstetrical writers and teachers re- 
garding the preparations of the prospective mother and her surroundings, 
are good, but in the majority of our cases in the eountry and in coun- 
try towns they are not practicable. The rank and file of our patients 
in country practice have ideas of their own regarding the preparations 
to be -made. Their mothers and grandmothers had babies, and as a re- 
sult the 101 details which the careful preparation for absolute asepsis 
requires, is regarded by them as a lot of useless fol de rol and needless 
trouble. The doctor, who insists on having this, that, and every other 



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78 THE CUNIQUE. 

good thing done according to his orders, will be voted a crank, and his 
ideas and plans will be regarded as those of a crank. Nine times out 
of ten he does not have the co-operation of a competent nurse, and one 
might as well try to educate a Hottentot in the ways of White House 
etiquette as to instruct the average old woman in the methods of hospi- 
tal technique. We may give our directions verbally or in writing. 
We may repeat them to the husband, the wife and the grandmother. 
We may instruct the prospective nurse regarding the preparations to be 
followed, but it is more than likely that we will have had our troubles for 
our pains. 'Tis more than likely that when we come to the bedside 
we will find a marked absence of the measures prescribed for the moth- 
er's comfort and safety. Sterilized vulvar pads are lacking. A stack 
of carefully covered sterilized towels is not in evidence. The rubber 
sheeting for the patient's bed, prescribed by the doctor, was proscribed 
by some neighbor's wife, who declared that an old lap robe would be 
just as good. The bath, which was advised, had been omitted. The 
vaginal douche, which was ordered, has been dispensed with, and even 
a careful cleasing of the genitals has been neglected. If the services of 
a hospital nurse have been engaged, it is quite possible and more than 
probable that because of reasons of economy she has not been sum- 
moned in time to carry out the orders of the would-be aseptic obstetri- 
cian. The doctor is summoned late. He may arrive in time to scrub 
his hands, or he may not, as things are coming right along. If fever 
follows, the doctor is the scape-goat. 

In hospital practice, all the details of careful aseptic preparation can 
be followed. In the country and in a general practice, we cannot de- 
pend on having our plans followed, and knowing this as every general 
practitioner does, can you differ with me when I assert that aseptic mid- 
wifery is an impossibility, despite the claims of aseptic enthusiasts to 
the contrary? Among the better class, where the trained hospital 
nurse has come to be recognized as a necessity, the practicability of 
formulating a plan of aseptic procedure is admitted. Practicable or 
not practicable we should have an aseptic ideal in mind. If that ideal 
is akin to perfection and we approach that ideal as closely as it is possi- 
ble we have fulfilled our part. Our duty has been done and if chills 
come, if temperature runs up and we lose our patient, we shall not then 
suffer from an accusing conscience. 

When engaged to attend a lying-in case, I am in the habit of giving 
a few stereotyped orders regarding the preparations to be made. An 
abundance of boiled water is to be prepared as soon as labor threatens. 
The patient is to take a bath as soon as she feels that she is to be 



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THE CLINIQUE. 79 



^ i sick." A thorough soap and water scrubbing of the external genitals 
is especially emphasized. The bed is to be freshly made up, using 
•clean sheets, and the patient is to don a clean night dress. An anti- 
-septic vaginal douche is to be given if a competent nurse is present. I 
-counsel plenty of fresh air, sunshine, exercise, and the use of an abun- 
dance of water during gestation. If the bowels, and kidneys, and skin 
are kept normally active, the danger of puerperal infection will be 
much less than if the patient enters upon her accouchement suffering 
from a lowered resistance due to the inevitable autoinfection which fol- 
lows and attends upon either protracted constipation or renal insuffi- 
ciency. I have no use for the rubber obstetrical cushion which many 
•obstetricians use; it is too big to be boiled, too cumbersome to be easily 
washed after it has been used and cannot easily be disinfected just be- 
fore using, especially if the doctor arrives late and the labor is rushing. 
Many of our more fastidious patients will object to using an article of 
that kind which is in promiscuous use, unless they know it has been 
boiled. I prefer to have a fold of rubber sheeting or oil cloth spread 
•over the lower sheet. Let this be covered with a clean quilt or several 
folds of blanketing, over this folded quilt a sterilized or at least a per- 
fectly clean sheet folded quarter ways is to be spread. This protection 
is ample to protect the bed from soiling and is more easily removed 
after the secundines are delivered than the rubber cushion. 

At the conclusion of labor, I wash the genitals thoroughly with a hot 
bichloride solution as I did before making my first examination. I 
cover the vulva with a large piece of bora ted cotton, over which is 
spread a napkin fastened, front and back to the abdominal binder. 
The napkins are to be put in a steamer, if we have no sterilizer, and 
thoroughly steamed, after which they are thoroughly dried in the oven. 
A homely and homespun way of sterilizing napkins, but an efficacious 
way, nevertheless. I always leave a nail brush with the nurse or at- 
tendant if she does not have one, and order that it be boiled every day. 
The brush may not be used as I wish it to be, but I leave it neverthe- 
less. In one place where I had given explicit directions regarding the 
use of the brush, I found the cook using it the next day to clean the 
-potatoes which were being prepared for the oven. Is it any wonder 
that I am skeptical regarding the practicability of an absolutely aseptic 
technique? I do not advise vaginal douches during the puerperum un- 
less we have a competent nurse in attendance. If they can be given 
jproperly, I believe that an injection once a day of a 2 % lysol solution 
is both restful and cleansing. 

" Forewarned is forearmed." If we practice asepsis thoroughly, 
-sepsis is not likely to develop, and as a result we will have less call for 
.antisepsis. 



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80 THE CLINIQUE. 

POST-PARTUM HEMORRHAGE. 

NATHAN STARR, M. D., CHARLESTON, ILL. 

My only excuse, if one is needed, for the selection of this oft used 
subject is that the post-partum gush or flow of blood that occasionally 
threatens the life of a parturient woman has lost none of its terrors for 
the accoucheur. When a student of medicine three things in obstetrics 
especially impressed themselves on my mind, and when my experience 
in obstetrical work began it was with considerable apprehension of cases 
of post-partum hemorrhage, placenta previa and eclampsia. 

This apprehension in regard to post-partum hemorrhage was hot 
lessened by the fact that in a short time in the community where I lo- 
cated one death occurred and another was narrowly averted from this 
cause. 

Good fortune rather than a wise precaution favored me during the 
first seven years of my practice and I did not meet a case. Since 
then I have not been so fortunate, but so far have had no fatalities. 

Of the many obstetric emergencies and complications that may arise 
few, if any, demand more expeditious, prompt and well directed inter- 
ference than the one under consideration. A practically bloodless 
labor, and one wherein the life of the woman goes out as* the result of 
blood loss represent the extremes met with in obstetric work. 

We cannot say in definite terms and measurements just what amount 
of blood loss constitutes hemorrhage, as what may be excessive loss in 
one woman may not in another. Estimates made to determine the 
average loss in labor show it to be about 14 oz. in normal labors and 
about 16 oz. in abnormal labors, with a greater liability to post-partum 
hemorrhage in the latter. 

It is estimated that 1-13 the weight of the body represents the weight 
of the blood. We know that in the pregnant woman the blood is pro- 
foundly altered in its constituents and increased in amount, and that 
in a woman of average weight this increase amounts from one to two 
pints, making the blood of the woman approximately six quarts. 

The loss of Yi of the amount of blood in the body is not ordinarily 
considered dangerous to life, but such a loss, in labor is excessive, and 
should be characterized and treated as a hemorrhage, and every precau- 
tion should be taken to prevent such a loss in the parturient woman. 

A rapid loss is much .more dangerous than a gradual one as the lat- 
ter is partially compensated by absorption from the tissues of the body. 
The loss is greater in multiparae than in primiparae and as a rule the 
loss increases up to and including the 7th labor. Most writers claim 



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THE CLINIQUE. 81 

that the length of the second stage has little or no influence on the 
amount of blood loss. My experience and observation leads me to be- 
lieve that a protracted second stage induces a greater loss, especially 
when it cannot be ended by natural efforts, and I would say that for- 
ceps delivery, per se, does not dispose to hemorrhage so much as the 
condition that made interference necessary, especially when due to 
uterine atony. However it should be borne in mind in using the for- 
ceps that a too rapid delivery may favor the development of this com- 
plication. 

Post-partum hemorrhage may be from any part of the parturient 
canal, the uterus proper, the cervix, the vagina or the pelvic floor. 
Usually it is from the placental site and is due to a deficiency in the 
contractility and retractility of the uterine tissue. A firmly contracted 
womb is a safe one and every effort should be made to secure this con- 
dition. As to preventive measures, any dyscrasia in the pregnant 
woman should be corrected as nearly as possible. A too precipitate 
labor should be delayed if possible and a too protracted one avoided. 
Particular pains should be taken to prevent the retention of particles of 
membranes, blood clots, or fragments of placenta. In other words the 
womb should be completely emptied. 

Bearing in mind the responsiveness of the uterine tissue to manipu- 
lation this efficient means of inducing contractions should always be 
kept in mind by the attendant, as a timely employment of it will often 
prevent excessive blood loss, and a routine practice of gently manipu- 
lating or kneading the womb through the abdominal walls, immedi- 
ately after the termination of the second stage of labor and continued 
through the third and for a while after, will well repay the operator. 

Treatment: If all the requirements of preventive treatment have 
been met then more radical measures must be at once resorted to if 
hemorrhage occurs. 

The source of the hemorrhage should at once be determined. If the 
womb is soft, relaxed and flabby you can be reasonably sure that the 
bleeding is from the placental site. If the womb is contracted and yet 
the hemorrhage continues, a cervical laceration involving the circular 
artery may be found, and this'of course will have to be treated by su- 
ture if the bleeding cannot be controlled by compression. Extensive 
perineal tears whether attended by hemorrhage or not should be repaired 
at once. 

If the hemorrhage is due to uterine inertia ergot or ergotine or trilli- 
um should be given as soon as possible, or ergotine injected hypodermat- 
ically; if the contractions are irregular and spasmodic, cimicifuga had 



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82 THE CLINIQUE. 

best be given. Mechanical measures are to be chiefly relied upon, and 
fortunately mechanical excitation is usually sufficient to overcome the 
existing uterine inertia or atony. Breisky's method should be used 
at once, that is, the fundus of the womb should be grasped with one 
hand and carried well forward and downward making compressions 
while the ends of the fingers of the other hand are pressed firmly against 
the anterior surface of the cervix when it joins the body of the womb or 
this failing Gooch's method can be employed, namely, the hand can be 
introduced within the womb and closed. It should be withdrawn dur- 
ing a contraction thus avoiding the danger of entrance of air into a 
uterine sinus. 

While employing these measures it would be well to have sterile water 
or vinegar or both heated to 115°or 120°F. and put in a syringe, and if 
the first named measures fail intrauterine irrigation should be employed. 
The next expedient would be to pack with sterile gauze. Asepsis 
should be observed in whatever method employed. 

Other expedients suggested and employed by some are the injection 
of warm water into the vagina and the application of hot water to the 
external genitalia. 

The use of strong styptics or astringents should be and has been al- 
most entirely abandoned, also the use of ice. As soon as the hemor- 
rhage is under control a normal salt injection should be given per 
rectum and repeated at intervals, or if the symptoms are more urgent 
the salt solution should be given intravenously. Care should be taken 
in the administration of cardiac tonics lest heart cramp or spasm be 
induced. 

As to the after effects. — During the first 24 to 36 hours there is 
almost sure to be a rise in temperature of from one to three degrees. 
Thirst and weakness are the most prominent features of the case. For- 
tunately in most cases these features rapidly disappear and the woman 
soon regains her normal condition. Occasionally however the weak- 
ness persists and it takes months to overcome the bad effects of the 
hemorrhage. In these cases the heart shows degenerative changes 
usually of a fatty character and such remedies as phosphorus, strychnia 
phos., and ferrum met. strych. cit, should be helpful. 

Case 1. Feb. 16, '96, was called to attend Mrs. Mc. — Multipara. 
Patient appeared weak and anemic. Labor progressed normally and 
but slight effort was required in expelling the child* It was I think 
the easiest birth I ever attended. Before the child was separated I 
noticed a free flow of blood. The placenta being detached was quickly 
removed. Almost total uterine inertia was present. The uterine sin- 



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THE CLINIQUE. 83 

uses seemed to stand wide open as a constant stream of blood poured 
forth. Patient faint, weak, slightly nauseated and calling for fresh air; 
ergotin was administered. Whiskey given for stimulation. The 
fundus of the womb was grasped by one hand and the cervix by the 
fingers of the other hand and after considerable manipulating the womb 
responded and began to contract. The ergotin was repeated for 
several doses and later strych. 2x and china lx were administered. The 
recovery was slow but uninterrupted. 

Case II. June 2, '02, attended Mrs. J. — Primipara. Nothing out of 
the ordinary occurred in the birth of the child, or the delivery of the 
secundines, but the labor was somewhat precipitate for the first one. 
I had made my toilet preparatory to leaving, when as is my custom I 
took the patient's pulse. It was above 100 and gradually ascending. 
Face showed decided pallor. Examined napkin and found it scarcely 
soiled. Passed hand over womb and could almost feel it ballooning out. 
By this time patient complained of sensation of nausea and dimness of 
vision. The pulse had reached 130 and was very weak. Ergotin was 
given and I quickly prepared to make examination. The exciting 
caused in this case of concealed hemorrhage was a clot just within the 
cervix. The clot was removed and its removal was followed by a gush 
of blood, partly fluid, partly clotted. 



THE DIAGNOSIS OF PREGNANCY. 

W. O. STOREY, M. D., FRANKUN GROVE, ILL. 

Physicians are frequently consulted to decide the existence or non- 
existence of pregnancy, in cases where it may be of immense import- 
ance in determining the reputation of a female, the legitimacy of a 
child, or even the life of a new being, and in instances where a pregnant 
woman is condemned to capital punishment. Hence a knowledge of 
the signs common to pregnancy, cannot be too thoroughly understood. 
Women with illegitimate offspring when suspected and interrogated, 
will almost always endeavor to mislead us by an obstinate denial, and 
even by the appearance of much indignation. This is usually true also 
of those who desire to abort or destroy conception whether married or 
not; therefore, we cannot be too cautious in giving full credence to the 
statements of any female upon this subject unless we have a sufficient 
acquaintance with her to justify implicit confidence in her assertion. 



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84 THE CLINIQUE. 

Again, when there is no desire to deceive, as either pregnancy is 
suspected from the presence of abdominal enlargement, suppressed men- 
struation, morning sickness, etc., it will often require all of our skill to 
make a correct disgnosis, while if our opinion be incorrect it is a very 
embarrasing situation we occupy. There is on record a case where a 
celebrated professor plunged a trocar into the gravid uterus and shoulder 
of the fetus in a woman whose condition he mistook for dropsy. I know 
an instance where a woman supposed to have erred, was examined by 
three physicians, who decided that she was some three or four months 
advanced in pregnancy; she denied the charge, but it was of no avail, 
her friends forsook her, her parents became harsh, severe and cold 
toward her, she pined away in secret, hiding her grief from the world 
and in a few months died. The results of an investigation showed a 
morbid growth, the true cause of her symptoms. Many such cases are 
today on record which emphasize the value and importance of a full 
acquaintance with all signs which are to guide us in our investigations 
and decision. We should exercise great discretion, and rely entirely 
on the indesputable evidence of our senses; not forming our opinions 
on one symptom but on a combination of unquestionable symptoms 
and if the least doubt be entertained, we should unhesitatingly express 
it; for it is much safer to remain in uncertainty, than to pronounce an 
incorrect diognosis. Women usually suppose themselves pregnant 
when after intercourse they find a cessation of menstruation followed by 
an enlargement of the abdomen and fetal movements at a proper time 
and generally they are correct, yet all these signs may be apparent 
without conception present. 

To determine a recent conception is not only difficult, but as far as 
the physician is concerned, absolutely impossible; yet many women 
resolve this point very correctly from certain voluptuous sensations 
peculiar to each, individually experienced during a fruitful copulation, 
and where they have previously given birth to children, having felt 
similar sensations, we have some grounds for believing them preg- 
nant. 

It is only when pregnancy has somewhat progressed that we are en- 
abled to diagnosticate with any degree of confidence, and the more ad- 
vanced this is, the more correctly can we decide. The signs of preg- 
nancy, as you all are familiar, are divided into the rational and sensi- 
ble ; the rational are subdivided into general, local and sympathetic. 

The general signs are those which result from increased activity of 
the nutritive functions, and the modifications which take place in the 
nervous system. The pulse is more frequent and strong, occasionally 



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THE CLINIQUE. 85 

intermittent in the latter stages, respiration more active. The changes 
in the nervous system are usually the greatest and most remarkable. 
The sensibilities become more refined, sometimes her nature appears 
completely changed. Although these signs are indications of preg- 
nancy, yet in the early months they are very obscure, and when taken 
alone at any period, very uncertain, and unless taken in connection with 
others hereafter mentioned are of very little aid in diagnosis. 

Among the local signs, that upon which females place the greatest 
reliance, is the suppression of menstruation; while this is a valuable 
and most important indication, and one that is very common with the 
pregnant woman, too much confidence must not be placed in it as an 
unerring sign; for it often happens that women fail to menstruate for 
one or several periods in succession without conception being present 
and this may or may not be accompanied with an augmented protuber- 
ance of the hypogastric region. This suppression may be due to cold, 
functional or organic disease of the reproductive organs, or other causes 
which should always be carefully investigated with a view to a correct 
solution. Again there are many instances where menstruation or a peri- 
odical sanguinous discharge is present during pregnancy — others where 
women have conceived without any previous monthly flow, and, occa- 
sionally, some menstruate regularly, or rather have a periodical dis- 
charge of blood only when pregnant. Usually when the catamenia has 
failed in the nonpregnant female the general health becomes deranged, 
but when this does not occur, and there is a gradual enlargment of the 
abdomen, morning sickness and the development of the glandular fol- 
licles of the areola, we have strong reasons for suspecting pregnancy 
especially in the married woman. A change in the color of the vulva, 
from its natural pinkish hue to a bluish tint, has been named as a sign 
of pregnancy; but this may be due to an obstructed circulation due to 
pelvic tumors or other abnormal conditions. A change in the color of 
the skin, called ephelis accompanies many women during pregnancy. 
It is a brownish, yellowish or earthy-colored stain usually occupying 
forehead, cheeks and even the neck and breast, but is not a constant 
sign of pregnancy. 

Dr. Schlesinger in an address before the Vienna Medical society pro- 
posed to determine pregnancy in its earlier months by thermometry. 
By investigation he found between the axilla and vagina a difference in 
temperature of 0.21° C and between the vagina and nonpregnant uterus 
of 0. 16° C the cavity of the uterus being higher than that of the cervix. 
The temperature of the fetus in utero is higher than that of the mother 
and which is imparted in a certain degree to the uterus. Pulse test: 



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86 THE CLINIQUB. 

The pulse rate varies in health from eight to ten beats per minute de- 
pending upon the upright or horizontal position, while in pregnancy- 
it remains unchanged, is not influenced by position. This is claimed 
by recent observers to be the most reliable of the many signs of preg- 
nancy. Increased desire to void urine especially at night is among the 
early symptoms; also fluctuation which has been detected as early as 
the seventh week, fluctuation combined with increased temperature, 
softening of the cervix and the areolar changes of the mammae are al- 
most certain signs. 

The sympathetic signs are usually confined to the digestive system, 
and are only useful as means of diagnosis when taken in connection 
with the nerve positive sensible signs. Among the sympathetic signs 
are nausea, vomiting, anorexia, pica, malacia, acidity of the stomach, 
heartburn and toothache. All the rational signs of whatever subdivis- 
ion are only important when accompanied with three sensible signs. 

The sensible signs are subdivided into the visible and audible and 
the tangible. 

The visible signs are those recognized by the eye, such as enlarge- 
ment of the mammae due to the sympathy with the uterus, occasionally 
the axillary glands enlarge. The increase in size, color, and sensitive- 
ness of the nipple about the beginning of the third month are consid- 
ered in this class, and are commonly present, yet taken alone cannot 
be depended on as certain, for pregnancy may exist without them, and 
they may occur from other causes, such as ovarian and uterine tumors; 
amenorrhea, etc. 

The areola, shortly after conception, changes color from its natural 
pink to a deep brown, and which is a more valuable sign in first preg- 
nancies than succeeding ones, as in the latter* it would be difficult to de- 
cide whether it was due to the former pregnancy or the one under ex- 
amination; by Hunter Smillie and Cozeaux it was viewed as a positive 
sign; but, notwithstanding this sign has its objections, viz., absent dur- 
ing pregnancy, modified due to the complexion of the female, and pres- 
ent where pregnancy does not exist, being induced by disease. A more 
positive sign, however, than this discoloration is the enlargement of the 
sebaceous glands, appearing like small tubercles near the margin of the 
areola. 

The secretion of milk is a sign of some value, yet we must remem- 
ber that it may occur in females who were not pregnant, likewise chil- 
dren and cases are on record where milk has been obtained from the 
breast of the male. Enlargement of the abdomen affords to the public 
a strong presumption of pregnancy, yet this may be due to other causes, 



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THE CLINIQUE. 87 

viz., accumulation of adipose matter in the omentum and walls of the ab- 
domen, ascites, uterine and ovarian tumors, amenorrhea, tympanites etc. 
Now if we have enlargements of the breasts areolar discoloration, changes 
of the mammae cessation of menstruation, increased uterine tempera- 
ture, fluctuation with usual health and previous morning sickness the 
inference is strong that conception exists. 

Quickening a term applied to a fluctuating or fluttering sensation ex- 
perienced about the fourth month may be mentioned in connection with 
the augmentation of the abdomen; owing to the fact that it may be ab- 
sent in some cases and that other symptoms, as flatulent motion etc., 
are sometimes taken for this symptom, we cannot depend upon it as a 
positive sign. If during the latter months of gestation firm and con- 
tinued pressure be made by the fingers against the opposite sides of the 
uterus, it will produce such disturbances to the uterus as to make it move 
vigorously. Also if the child be alive the same results may be felt by 
dipping the hand in cold water and applying it suddenly over thi ab- 
domen. While the signs are strong evidence of pregnancy, yet its ab- 
sence does not prove the reverse condition, as the child may be dead or 
very feeble. 

We may also mention the pecularity observed in the urine of some 
pregnant females, first described by M. Naucha in 1831. Dr. E. K. 
Kane, of Philadelphia, has by investigation determined that this is not 
peculiar to pregnancy but may occur during the presence of milk in 
the breasts, especially if it be not freely discharged from the mammae 
and that its presence is rather an indication of the existence of this 
mammary secretions than of pregnancy. The audible signs are those 
detected by the ear with or without the aid of the stethoscope among 
which is the placental sound, which is variously represented as resemb- 
ling the blowing of air, the cooing of a dove, drone of a bagpipe, etc. 
It is always synchronous with the mother's pulse most usually heard 
on the sides of the abdomen over the course of the iliac arteries. It is 
usually heard about the 4th month. This is neither a constant nor posi- 
tive sign of pregnancy as it may be due to other causes, as aneurism, 
abdominal tumors or whatever may compress the arteries and has been 
heard even after delivery. 

The sounds of the fetal heart differs entirely from the placental as it 
closely resembles the ticking of a watch and differs materially from the 
mother's pulse in rapidity, beating from 120 to 140 in a minute, being 
so rapid at times as to render it impossible to count them and returning 
to their natural character without auy cognizable cause. As in the 
quickening signs so with the pulsation it affords no positive signs be- 



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88 THE CLINIQUE. 

cause of death or feeble condition of fetus, also its position or the ex- 
cessive quantity of liquor amnii may destroy sound. 

The tangible signs are exceedingly important in assisting us in our 
diagnosis, for by them we are not only enabled to determine this condi- 
tion but also its degree of advancement. 

Abdominal palpation or exploration may assist us in forming a cor- 
rect diagnosis of pregnancy, and can be practiced in all cases with few 
exceptions, which may be owing to an excessive thickness of the ab- 
dominal walls. Another mode of determining the presence of preg- 
nancy is from the passive movements of the fetus in utero or balotte- 
ment; these motions depend upon physical laws and are entirely inde- 
pendent of the vitality and muscular strength of the fetus as they are 
present -whether it be dead or alive. As a certain size and weight of 
the fetus is required we cannot practice balottement in the early months 
of gestation. From the above statements it will be observed that in 
order to determine the condition of pregnancy with certainty, the prac- 
titioner will be obliged to procure a delay until the motions of the fetus 
and other signs are manifested with force and distinctness, and which 
will usually be at the 4th or 5th month; though from feebleness of the 
fetus he may have to wait a still longer period. In all difficult cases 
the physician should, when called upon, never positively affirm the 
existence of pregnancy, until he has distinctly perceived the pulsations 
of the fetal heart, balottement and the proper changes in the uterus. 



ALBUMINURIA IN PREGNANCY.* 

GILBERT FITZ-PATRICK, M. D., CHICAGO, ILLINOIS. 

Your president has asked us " To settle this question now and for all 
time." Would that we could, though even in this brilliant age, with 
its great horde of investigators and experimenters; with its focus of 
great learning cast upon every shred of pathology; tracing it step by 
step to its original physiology; with all our analyses and observations, 
the best conclusions we may reach will act only as stepping-stones for 
the Father Time of Learning in his perpetual journey from the dark 
past into the brilliant future. 

Though we may not solve the mysteries of this great problem to- 
night, each day brings us nearer its final goal; when the diagnosis of 

* Presented as opening address in Symposium on Albuminuria, to the Chicago 
Homeopathic Medical Society, January 17th, 1907. 



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THE CLINJQUE. 89 

Albuminuria, with its etiology and treatment will be a mere process of 
deduction, with the personal equation of each case taken into consider- 
ation. 

Time was, not long ago, when the relation of albumin to eclampsia, 
spelled terror to the heart of the medical attendant. Now, given a case 
without tube-casts from the kidney, the ultimate result of diet, hygiene, 
and internal medication is quite satisfactory, both to- the patient and 
physician. Even in the more serious cases, with a deficient urea, de- 
creasing urine, and a disproportionate co-efficient of ammonia, we are 
today restoring a large per cent, of these women to a normal health. 

The fetal mortality still remains high, about 50% (Wright), but the 
pathologic findings in the placenta is sufficient unto itself to account 
for the fetus moribund.* The fetus may die in utero, or premature 
labor supervene. Yet it may be this very pathology of the placenta 
that causes the albuminuria, and, since the fetus, always poorly nour- 
ished, is entirely dependent upon a perfect placental circulation, it 
would naturally follow that the fetal mortality would reach a much 
higher per cent, than that of the albuminuric mother, whose health 
equilibrium depends to a very great extent upon the perfect working of 
her emunctories. 

Strictly speaking, albuminuria as so viewed today, is but a symptom. 
One of many symptoms, each of which bespeaks a general systemic 
condition, an auto-infection; the result of certain toxic substances cir- 
culating in the body. 

To ascertain, 1st, — What are these toxines ? and 2nd, — What are 
the factors, that produce them ? 

These are the two great questions confronting us, and must be ans- 
wered in solving this, the most perplexing complication of pregnancy. 
Perplexing, because the per cent of albumin in itself is no criterion as 
to the gravity of the situation, except in rare cases, when it reaches a 
high per cent and then the physical symptoms are such that a diagnosis 
is evident. 

Albuminuria of pregnancy must be sharply distinguished from a 
certain variety of disorders associated with pregnancy in which albumin 
is found in the urine, i. e., as those of renal origin antedating the preg- 
nancy. We are not dealing with this latter class, but with the album- 
inuria of toxic origin, depending upon the pregnant state, in which 
other clinical features of great importance are found besides the pres- 
ence of albumin in the urine. We must be careful to exclude in addi- 
tion to pre-existing renal disease, such transient causes as fatigue, 
mental excitement, hysteria, etc. It may be necessary to secure the 



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90 THE CUNIQUE. 

urine by catheterization, since vaginal secretions may contaminate the 
specimen and show albumin of varying per cent. (Eden). There is 
no doubt that in a large majority of primiparae and in a small proportion, 
of multipara, traces of albumin appear in the urine during normal 
labor, which disappear when labor is over. This may partially account 
for the contradictory statistics that have been published as to the fre- 
quency with which albuminuria is to be found in the pregnant woman; 
the proportion varying from 3 to 50%. Excluding parturition, the 
frequency with which albuminuria appears in the pregnant woman 
probably does not exceed 5 to 10 % . 

The albuminuria of pregnancy is practically confined to the latter half 
of the period of gestation, and seldom manifests itself before the 28th 
or 30th week. It is much more frequent in primiparae than in multi- 
para. Cases differ greatly in severity. In some there is only a mod- 
erate amount of albumin in the urine, which readily disappears under 
treatment, or even when persisting, it may not interrupt the develop- 
ment of the ovum or the course of pregnancy. Every case, however, 
requires careful management, for the possibility of other and more serious 
symptoms developing, is always present. (Edgar), When a character- 
istic symptom, like ptyalism develops in pregnancy, we can hardly es- 
cape the conclusion that a toxic substance is at work. 

In the practice of Obstetrics, we must distinguish between women, 
who have some organic disease, and those, who are suffering with func- 
tional insufficiency. It is reasonable to believe that certain individuals 
are born with, or, through improper living, acquire weak organs. Let 
such a woman become pregnant with all it means to her emunctories, — 
their failure to carry the increased burden is soon manifested by a great 
variety of disorders; an autointoxication, with such symptoms, (Hanot ), 
as alteration of character, lassitude, headaehe, vertigo, insomnia or 
somnolence, salivation, neuritis, pruritis, morning sickness, visual dis- 
turbances, constipation, epistaxis, urobilinuria, alimentary glycosuria, 
while higher degrees of intoxication include: mania, icterus, edema, 
albuminuria, varices, retinitis, hyperemesis gravidarium, and convul- 
sions. 

Although the majority of albuminurias terminate favorably, we would 
warn against too much temporizing. These are treacherous cases, and 
readily pass into eclampsia; convulsions may suddenly appear; blind- 
ness supervene, followed by coma; or premature detachmerjt of the 
placenta may take place. 

In conclusion, while albumin may be found even in considerable 
quantities, without marked evidence of ill health, it is so intimately re- 



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THE CLINIQUE. 91 

lated in pregnancy with a more or less severe toxic condition, that it 
should receive the most careful, scientific consideration from the ac- 
coucheur to whom the woman trusts her life. 

E. M. Bruce, M. D. — It does not seem to me that it is at all probable 
that there is any great difference between the albuminuria that occurs 
in pregnancy, and that which may be present in a great many other 
ailments of life. Some of the albuminurias of pregnancy are associated 
with most dire results to both mother and child, and others make no 
apparent difference to any one except to pnt a few more gray hairs on 
some doctor's head. I take it that the thing we would like most to 
know is what role does albuminuria play as a causative factor in eclamp- 
sia? 

Most cases of pregnancy have some albuminuria at some period of 
the gestation, if it is carefully looked for. The worst cases of eclampsia 
I have ever seen came on without any warning. In one of them, one 
which was bad enough to satisfy the most captious, there was no albu- 
min in the urine 12 hours before the first convulsion, nor 36 hours 
after delivery, (Dr. Cobb will remember the case) nor was there any 
other evidence of kidney disease. The patient had been as well as pos- 
ible during the gestation. Simple albuminuria should not be con- 
founded with acute diffuse nephritis which may occur during pregnancy. 
Albuminuria means the presence in the urine of serum-albumin, serum 
globulin, or acid or alkaline albuminate. This maybe caused by 
changes in the blood (hematogenous), changes in blood vessels (vas- 
cular), or changes in tubules of gland (parenchymatous) or from edema 
of the whole gland (venous congestion). A low tension and slow 
blood current favors the transudation of the albumin. 

Any of these conditions may occur during pregnancy and they also 
may occur in many other phases. 

In most of the cases I feel that the doctor may lure himself into a fair 
state of security if there is a good nitrogen output per day (not per urin- 
ation) and if the urine has a good, bright color. The most of the fatal 
cases of eclampsia, the kidney has not been found altered in structure. 
Remember in looking up these things one should carefully differentiate 
between the cases that were clearly diffuse nephritis and those that were 
eclampsia. The treatment should be considered under the heads of 
hygienic, drug and surgical. The real cause of eclampsia is one of the 
many things we do not know. 

Clifford Mitchell, M. D. — What Dr. Bruce has said about the sudden- 
ness of these attacks in some cases is undoubtedly true, and I myself 
have examined samples of urine 24 hours before convulsions occurred, 



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92 THE CLINIQUE. 

in which I have been unable to find any evidence of impending trouble. 
However, when we do find albumin in the urine of pregnant women 
we need to know what is going to happen. That is a matter to which 
I have given considerable attention, and I have followed a good many- 
cases of albuminuria in pregnancy through with careful record of them, 
and I can tell what has happened in those I have seen. 

As Dr. Bruce says the post-mortem examinations in the true eclamp- 
tic cases show very little change, if any, in the condition of the kid- 
neys. We find a somewhat enlarged kidney, somewhat pale in color 
with more or less degeneration of the tubular epithelium, but the 
change is not necessarily at all marked. It therefore follows that the 
evidences in the miscroscopic field of the urine will not be very marked 
in the true eclamptic cases. But the question comes up whether we 
can possibly, by the examination of the urine, distinguish the true 
eclamptic cases from those that are nephritic or due to some other con- 
dition. I do not believe it can be done in all cases. At the same time 
there are certain indications which will do much to comfort our minds, 
tell us what we may expect, and give us some idea what we may have 
to do. When I find albumin in the urine of a pregnant woman the 
first thing I try to ascertain is whether or not there are waxy casts 
present. It is generally admitted that waxy casts indicate considerable 
kidney damage and, as very little kidney damage exists in eclampsia, 
it follows that if waxy casts are present we have a nephritic condition, 
a pre-existing nephritis aggravated no "doubt by the pregnancy. But 
suppose we do not find waxy casts. Suppose we find merely hyaline 
and granular casts. I have found granular and hyaline casts in at 
least one case that seemed to be an eclamptic one, but the casts were not 
found in great number, and were not found at all until a week or ten 
days before convulsions. I once obtained the urine drawn just after 
death from coma, by catheter, and in that sample found many granular 
and hyaline casts but no fatty or waxy ones. If we find granular or 
hyaline casts without waxy ones for some weeks or months, and these 
casts are present continually from week to week, the chances are we 
have really a nephritic condition and not the true eclamptic condition; 
but if these casts occur just before convulsions it does not necessary 
follow that the case is a nephritic one. 

There is one thing I have verified in several cases. If you find blood, 
blood casts, or reddish granular casts, you may be almost certain that 
case is one of nephritis, and not a true eclamptic one, because hem- 
orrhagic nephritis is often the mildest form seen, and some cases escape 
observation altogether until exacerbated by pregnancy; and, on the 



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THE CLINIQUE. 93 

other hand, these findings are never present so far as I know in true 
eclamptic cases. 

What is the practical value of establishing the fact that we have 
nephritis rather than true eclampsia? The indications for induction of 
labor in nephritic cases are fairly definite. The cases I have diagnosed 
as nephritis have gone through labor without convulsions, but after 
labor the danger has been from the heart. If there is present, ascites, 
enlarged left ventricle, retinitis, dyspnea or irregular pulse, then, the 
indication is for induction of labor. If there is merely albuminuria 
without casts, the case will not necessarily be eclamptic, especially if 
the albumin remains about the same, and the urine is passed in normal 
quantity. But suppose, on the other hand, we find a sudden decrease 
in the amount of the urine, together with sudden increase in color, and 
in amount of albumin? I have observed convulsions soon occurring in 
a number of such cases. The convulsions may not have" been due to 
the albumin etc. , but just the same we have been given due warning; 
not many hours beforehand perhaps, but still a warning. There is no 
question however but that there are exceptional cases where the warn- 
ing is slight if any. I would like to examine the urine passed an hour 
or two before convulsions in such cases, but never having had the 
opportunity for examination in such cases I cannot, of course venture 
to express any opinion regarding them. 

E. Stillman Bailey, M. D. — It is my experience that very many of 
the lesions that are attending conditions of pregnancy are simply trans- 
itory, and have nothing whatever in common with pregnancy itself. 
Pregnancy is incidental. Albuminuria is a part of this program. We 
know that 12 % of the women having syphilis in the early stages will 
have some albumin in the urine, and in chronic stages two or three per 
cent have it right along. Yet we know some syphilitic women have 
been unfortunate enough to become pregnant; so we have an albumin- 
uria that is dependent upon a lesion that has nothing to do with preg- 
nancy. Schroeder, in his clinic, determined that from 3 % to 5 % of 
his patients who were pregnant had some albumin in the urine; while 
his neighbor in the same hospital, only in the opposite room on the same 
floor, determined there were about 5 % of cases of albuminuria in which 
the patients were not pregnant. 

Dr. Harvey, the great English obstetrician, reports that he finds 
about \2%% of cases of albuminuria in pregnant women. 

There is another interesting fact that goes with albuminuria, and it 
is a little startling perhaps to say that every third woman who has 
given birth to a child has had some interference with the position of 



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-94 THE CLINIQUE. 

the kidney. The kidney is dislocated or displaced through the traumat- 
ism of labor. 14 % of these cases, having dislocated or displaced kid- 
neys, are subject to albuminuria. Yet it is apparent that if these cases 
become pregnant again it is not in consequence of the pregnancy that 
they have albuminuria, but in consequence of the displacement of the 
kidney itself. 

When albumin is slight in amount and is without casts, as Dr. 
Mitchell says, or there is very little of the epithelium thrown off, or it 
is unattended by any form of dropsy or anasarca, it could be classified 
as more physiological than pathological, in my estimation. I believe 
that the severe cases of albuminuria are in a class by themselves. 

There may be severe changes in the kidney that occur in a previously 
healthy organ simply as a result of pregnancy, and they belong to the 
dangerous class of cases. These cases are rare, but they are the ones 
that give the unfavorable forecast of convulsions, anasarca, dropsies 
and all the horrible things that come, I wont say as the result of albu- 
minuria, but as the result of the conditions that are imposed upon the 
.system, of which albuminuria is a forerunner or forecast of the cause. 
With the continuation of true nephritis right through the period of ges- 
tation, and when there is present the abdominal tension, plus venous 
congestion and vaso-motor disturbances, you have the forecast of con- 
ditions of convulsibility. 

Then, too, I am more and more convinced as time rolls on and more 
definite study is given to this subject, that a good many of these cases 
we speak of as albuminuria cases, are albuminuria all right, but they 
.are more than that. As the result of conditions present, toxemias ex- 
ist, and that patient is a poisoned patient; all through her pregnancy 
she carries with her the results of imperfect metabolism, she is a victim 
of lethal poisoning. The burden of elimination comes on the kidneys 
■during pregnancy, the kidneys in turn become weakened by these tox- 
emias, and in addition there is the toxic effect that comes from the fetus. 
Hyperemias and the increased intra-abdominal tension are also potent 
contributing factors. 

I was very much in hope that Drs. Bruce and Mitchell would take up 
the immediate remedial treatment. It perhaps is incumbent upon us 
to say something about the remedies that are useful, but I insist the 
hygienic conditions must be perfect through all of the pregnancy. 
There is no other escape. The toxines must be dealt with as they ap- 
pear in the body, and I believe one of the greatest remedial agents, con- 
nected with this form of trouble, is to be found, not in the drug, but in 
the diet. I feel as though the great advance that has been made in 



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THE CLINIQUE. 95 

changing these cases from fatal cases to those of recovery, is very largely 
due to the fact that a perfect physiologic diet can be maintained, that 
will be eliminative and not allow the increase of the toxemia. There 
are a few cases, (one in 500, says DeLee), where there is the kid- 
ney of pregnancy, where the nephritis exists and continues in spite 
of all that is done. 

I have been unfortunate enough to have seen about four of these rare, 
strange cases. Terebinth in one case seemed to give some results. 
One other patient was kept under the influence of chloroform for several 
hours which, according to present understanding of the use of chloro- 
form, is a detriment rather than a benefit. If chloroform is to be used 
as an anesthetic to strip the kidney of its capsule, well and good; then 
the tension is removed and the hyperemic condition may be entirely 
relieved for the time being. 

Under the diet treatment, statistics show that up to the eighth 
month patients can be carried along in safety, and diet restrictions 
can carry the patient even with the appearance of convulsions up to the 
second stage of labor. That is, the patient can be dieted through the 
first stage of labor; then comes the chance to save the child if this 
can be done. The second stage of labor can be carried through 
rapidly by use of the obstetric forceps, and, if the toxemias have not 
prevailed to the extent of destroying the child or mother, it is the reas- 
onable thing to do. Diet and eliminate the case along till dilatation 
be complete, and delivery may be made even though the mother may 
be In a convulsive state at the time. 

Sarah M. Hobson, M. D. — In the course of the discussion there oc- 
curred to me two types of these cases which I presume every one of you 
can duplicate out of your own experience, and to give the matter a 
clinical turn let me briefly give you those two types: One, a woman in 
her first pregnancy, had a slight convulsion just before delivery of the 
child; everything went on normally after that. In the second preg- 
nancy the urine was heavy, under the ordinary boiling test, with 
albumin for a month or so before normal delivery. The third was a 
miscarriage. Then came four normal deliveries. The woman is still 
living doing the work for her six children and the husband. 

The other case, which Dr. Buchanan and Dr. Mitchell will both re- 
call, from analysis of the urine showed no evidence of kidney disease. 
There was no albumin and although the patient was watched very care- 
fully that case ended fatally in convulsion. The thing I remembered 
in that case, the two or three times I saw the patient and have thought 
of so many times after, was a mental symptom, that same mental 



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96 THE CLINIQUE. 

symptom which I have seen several times in cases of carcinoma, a cer- 
tain fixed gloom, a sense of fatality in the mind of the patient, a black- 
ness almost like that which patients have sometimes described in on- 
coming insanity, and I believe that mental symptom is important in 
these gloomy cases, in some instances at least. 

The etiology and pathology are still somewhat obscure. The hygiene 
of these cases to my mind is as clear as daylight. Begin with the very 
beginning of pregnancy, remembering that pregnancy is a physiologi- 
cal process and not a part of pathology. If it is pathological, there is 
something wrong. But the patient is living for two, she is breathing 
for two, she is eating for two, she should be sleeping for two, and I 
think the essentials of hygiene in this particular phase of pregnancy is 
that the matabolism be made as perfect as possible and the execu- 
tion fully adequate. That is easy to say but it is harder to accomplish 
the thing with the patient. It is harder to make that patient see why 
she should increase her hours of sleep, why she should increase the 
amount of oxygen which means not only out-of-door exercise but the 
amount of fresh air in the living rooms not only in the daytime but in 
the sleeping room at night, in the actual hours spent in quiet resting 
and sleep if possible, and in an active rather than a sedentary life. I 
think there is no exercise so beneficial as the lighter part of housework 
for the occupation during pregnancy. It is infinitely better than for 
the woman to be set aside in the household, doing nothing. The activ- 
ity keeps her moving about, moving her muscles, breathing deeper be- 
cause of the work she is doing, together with such out-door activity as 
does not bring upon her excessive strain. That bars out certain things, 
such as shopping in bad air, going to concerts in heated, crowded 
rooms, but she should have the out-door exercise which is agreeable. 
The other items in hygiene we all know and it would be simple reitera- 
tion to mention them. Yet dress is so important in the early months 
of pregnancy, so that the uterus shall rise vertically in the trunk, up 
against the liver, pressing up the diaphragm up to the lungs, giving 
the straight line from the armpit to the ground — instead of the down- 
ward pressure caused by close dressing, the downward pressure on the 
abdominal organs. I think not one of us could recall any rule in 
hygiene that should not be enforced emphatically during pregnancy. 
(Applause). 

James West Hingston, M. D. — What are we going to do about it? I 
think that is the most important question to answer. Your secretary- 
asked me to come this evening to discuss the homeopathic medical 
treatment of these cases. There is one thing that is very plain to every 



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THE CLINIQUE. 97 

observing physician, and that is that every dangerous case has its fore- 
running symptoms. So far as my personal observation is concerned, 
I have never seen a case of eclampsia of this kind where it was not fore- 
run by a long-continued series of symptoms that were ample dan- 
ger signals to the observing physician, and these are mostly of a nerv- 
ous type. They have not much to do with the appearance of the ex- 
tremities or the analysis of the urine; but the nervous symptoms, so 
far as I know them, have always appeared and pointed unerringly to 
some one of our homeopathic remedies, and I should dislike to confine 
myself in the treatment of these cases to any single remedy based upon 
a pathological idea, but I believe that if you will observe the nervous 
phenomena together with the physical signs closely and apply intelli- 
gently the homeopathic remedy you will escape a great majority, if not 
practically all these cases, providing the case is taken from the start, as 
was suggested by Dr. Hobson, and an early observation made of all the 
pathological symptoms that appear in the pregnant woman. And they 
commence at the very earliest hour. Many a woman has had her first 
nervous symptom the morning after the intercourse that has produced 
in her a pregnancy, and these nervous phenomena would continue and 
they would be accompanied by disarrangement of the digestive tract 
and other objective symptoms. I think it would be entirely wrong to 
follow the suggestion, I believe of one of the disputants, in excluding the 
acute inflammatory conditions of the kidneys from this condition that 
we are considering tonight, because those acute conditions are fre- 
quently built upon what we might call the subacute or special condi- 
tion that exists during this time, and they should be closely taken into 
consideration and mastered at the time and dispelled, so that the patient 
might go along in the regular course of her pregnancy untrammelled 
by any remnants of what might be left after an acute kidney trouble. 
To illustrate, I will mention a few of the remedies I have used in cases 
where I have seen those danger signals. 

Apis mellifica must certainly be one of them. It has many of the 
symptoms that forerun these dangerous conditions, as albuminuria, 
swollen extremities, and the puffiness of the face as characterized by 
the edema under the eyelids, yet these are not the most important 
symptoms, but they are the symptoms that you will observe early in 
these conditions. The especial symptoms for the indication of apis 
would be in the actual danger point of convulsions, that they be brought 
on by what was suggested by one of the speakers, some fright, rage, or 
a fit of jealousy. In the latter months of pregnancy the woman may 
have come into a condition of jealous rage, or she may have been 



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98 THE CLINIQUE. 

severely frightened and afterwards gone to sleep and on awakening 
gone into a convulsion, the first eclamptic convulsion. These would 
be marked symptoms for apis. 

Arsenicum has the objective symptoms we see under apis and in 
addition those peculiar symptoms recognized as fear of death; but a 
remedy that has more settled gloom is 

Aurum. — The gloom settles right down over the patient. They 
think they never will get well, and therefore want to end it all, and are 
inclined , to commit suicide. They may cry at all times without or 
with provocation and that is a marked indication for Pulsatilla. Others 
again have the same fear of death, are very gloomy , with headaches that are 
inclined to start in the neck, extend to the head and forehead and it 
feels as though the head would burst or the eyes would protrude from 
the sockets, and we then must think of gelsemium. These are the 
symptoms that will point to the homeopathic remedy, which, if ad- 
ministered, will cause the symptoms to fade away, and if the symptoms 
are faded away there is nothing left. And I honestly believe that if 
you make your patient feel so well that she will not complain of any 
symptoms and by the closest questioning you cannot elicit a symptom, 
nervously or otherwise, you will have no fear of eclampsia or any other 
untoward symptom of pregnancy. 

The President. — Dr. Bailey said we must guard the heart in these 
cases. That is illustrated by an incident that happened yesterday 
afternoon. I was called up by a Christian Science healer in Chicago 
who said one of her patients had just given birth to a baby and had 
stopped breathing and she could not make her begin again. The state- 
ment seems almost childlike. The woman did not begin again. It 
only shows the various accidents that can happen to a married woman. 
It seems the baby is only an incident — everything else is the important 
feature. 

Joseph Pettee Cobb, M. D. — I think we do not know much about 
what effect albuminuria in pregnancy may have upon the child. It is 
true that in many instances a woman miscarries when there has been a 
continuous albuminuria or for only a limited time, and that the mis- 
carriage very frequently produces a child of imperfect development. It 
is true also that some of the children born at term, after an albuminuria 
for an indefinite length of time, are poorly developed and do not have 
digestive powers to the extent that the average child does, and that this 
occurs more frequently in albuminurias of pregnancy than it does in 
some other diseases of pregnancy. I do not know that it is true. I 
also am very confident that transitory albuminuria in the later months 



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THE CLINIQUE. 99 

only of pregnancy does not seriously affect the condition of the child. 
I would not feel that there was any absolute, determined effect upon 
the relationship of the child and the albuminuria of pregnancy any 
more than in any other disease or condition which exhausts the wom- 
an's strength or power of giving sufficient nourishment to the child. 

The case which Dr. Bruce referred to, that I saw with him, gives a 
very suggestive point with relation to its influence on the child. In 
that case he had the good fortune to make a urinalysis a few hours be- 
fore eclamptic seizures occurred near the end of the period of gestation, 
though not at what was supposed to be the normal time for labor, and 
there was no albumin in the urine at that time nor during the first and 
second days afterward. The labor was induced and a living child was 
born which was well nourished and seemed to do very well during the 
first two or three days while it was fed upon hot water with salt and a 
little cream. On the third day the milk came with something of a 
rush, and the baby was made use of to empty the breasts. It emptied 
the breast well for the first time on the third day, it had a fairly good 
stomachful and felt fairly well satisfied with it, went to sleep, had a 
convulsion in half an hour and later died. That made a suggestion to 
my mind that whatever produced the eclamptic seizure on the part of 
the mother, and it was not albuminuria for, as I explained, there was 
no evidence of nephritis either before or after induced labor, — whatever 
produced the eclamptic seizure permeated her system to the extent that 
it was excreted together with the milk and was sufficiently poisonous, 
lethal, to cause death in the child* That is the only observation I have 
had of the kind and I have been unable to find any similar recorded in- 
stance, so I cannot offer it as a demonstration but only as an instance. 

My observations have been to an extent along the clinical line and in 
relation to the mother, and while they partake more or less of the ex- 
perience of the different speakers, we have not emphasized enough the 
fact that while eclamptic seizures occur in women who have not had al- 
buminuria, and while albuminuria does not always produce serious trou- 
bles, there is a greater proportion of eclamptic seizures in women who 
have albuminuria during pregnancy and that there is a large propor- 
tion of other disastrous results in such patients. 

It does not seem to me the statistics quoted by Dr. Bailey, 5 % of all 
the women going to the obstetric ward had albuminuria, or 5 % of women 
going to another ward also had albuminuria, is conclusive evidence 
but that it is simply an incident and an accident of pregnancy. Those 
women who came to the ward across the hall and were not pregnant 
probably were pathologic. From 3 % to 5 % does not represent the in- 



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ioo THE CLINIQUE. 

stances of albuminuria in normal, healthy women and I do not know 
any reason why we should compare as statistic evidence of that kind 
the pregnant women with a group of varied or other women. Possibly 
I do not know what the other women were; they may have represented 
a group or variety of pathologic conditions in which albuminuria was 
equal, an even per cent. I throw that out as a suggestion, that statis- 
tics even though corroborated and collected by the best observers and 
deductions deduced from these statistics by good observers are not al- 
ways positively, in my mind, supporting the deductions of the man who 
made them. It seems to me nothing tells so many wrong stories as 
statistics. 

I would like to call attention to the remarks of Dr. Hobson. They 
ought to be emphasized: The early treatment of these cases along 
hygienic lines. I believe Dr. Hobson has practically covered the field. 

E. -M. Bruce, M. D. — I would like to say that Dr. J. J. Gill recently 
read a paper before the Chicago Medical Society I think, in which he 
gives an instance of convulsions coming on in the child after putting 
it to the breast where the mother had had eclampsia. 

Burton Haseltine. M. D. — In regard to the effect upon the eye, of 
the albuminuria of pregnancy, a few words will cover my knowledge of 
the subject. The albuminuria of pregnancy is not of great clinical im- 
portance to the oculist, occurring, as it does, so very rarely, approxi- 
mately one case in 3,000 pregnancies as far as we know, but it is of 
tremendous clinical importance to the patient when it does occur. It 
has been mentioned once or twice by previous speakers, by one in con- 
nection with varieties of headache and irritation of the stomach. It 
does not belong there. By another speaker it has been mentioned in 
connection with severe cardiac and respiratory symptoms as well as ne- 
phritic and renal symptoms. It belongs there. In those cases where it 
does occur it is of overwhelming importance. The reason is, the eye is the 
one place, where we can look in and see a process going on in the central 
nervous system without an operative procedure. The optic nerve is 
not a peripheral nerve, it is part of the central nervous system, and 
when symptoms occur there they mean much. They occur late. These 
are not cases where the occulist should make the original diagnosis. It 
used to be a matter of some gratification to us that we sometimes were 
the original discoverers of renal disease, as it was then called, Bright's 
disease as we call it now. It is now not so much to the credit of the oculist 
as it is to the discredit of the attending physician. Especially would it 
be so in pregnancy. There never should occur a retinitis in pregnancy 
discovered originally by the oculist. It might be that the visual symp- 



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THE CLINIQUE. 101 

toms would be among those attracting attention, but other than visual 
symptoms should be observed previously. The retinitis of pregnancy 
is not the typical albuminuric retinitis, with white spots but it is an acute 
inflammatory edema of the retina that is simply an expression of in- 
flammatory processes going on elsewhere, and this is one of the reasons 
why it is so important. If occurring late in pregnancy it may some- 
times be temporized with, because there are cases where considerable 
loss of vision has occurred about the end of pregnancies that have gone 
on and recovery of vision has tsken place. Occurring earlier in preg- 
nancy it is of very grave significance, not merely as regards vision but 
as regards life, and the responsibility of the physician in such a case be- 
comes tremendous. 

Clifford Mitchell, M. D. — I would like to have your experience, Dr. 
Haseltine, in regard to the prognosis in cases of retinitis developing 
during pregnancy as compared with retinitis as we ordinarily find it. 
In ordinary retinitis, not in pregnancy, we say death takes place in two 
years. You speak of two kinds: one in the early months and one in 
the later months. What is your experience in regard to the recovery 
of those cases? 

Burton Haseltine, M. D. — I have had no personal experience with 
retinitis occurring in pregnancy. I have had experience in both forms 
of retinitis occurring with nephritis and albuminuria, in other than 
pregnant people, and I wish to say, in regard to prognosis, it is a mis- 
take to suppose it means death in two years. The condition implies 
the whole pathologic process called by various names involving the cir- 
culatory disturbances that you are familar with, and the heart condi- 
tions along with kidney conditions, arterio-sclerosis, Bright's disease. 
This is simply one of the manifestions; and you are all familiar with the 
fact that patients may go on with this condition for many years and the 
occurrence of retinitis in such a case does not prognose anything. 

The occurrence of acute retinitis if due to nephritis, does not neces- 
sarily prognose anything in regard to life. But it does in regard to 
vision, and that is serious. That is the point I should have emphasized. 
The changes which take place in the retina and optic nerve are destruc- 
tive to vision and cannot be recovered from. They take place quickly. 
Authorities agree that the vision in albuminuric cases, even during 
pregnancy, will probably never be much better than it is at the time 
the pregnancy is interrupted or in any other way the process is stopped. 
And if allowed to go on, occurring in the first half of gestation, the 
prospect of useful vision at the end of gestation is extremely small. 



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102 THE CLINIQUE. 

CLOSING DISCUSSION. 

Gilbert Fitz-Patrick, M. D. — One observer considers Eclampsia 
under two heads, acute, and chronic. The obscure cases referred to by 
Dr. Bruce, in which there are no premonitory symptoms, are classed as 
acute Eclampsia. All the rest are designated as chronic or chronic 
Eclampsia. Often in these acute Eclampsias, the question might arise : 
— " is it Eclampsia? They may have made a mistake in diagnosis/' 
However, I would not question the diagnosis of any one, who has met 
with Eclampsia. 

Another authority says, Eclampsia is contagious, that it is transmit- 
able through the air. I recall a striking example in which two sisters 
and a sister-in-law, living in the same community, all had Eclampsia 
within six months. Two of them died, and one recovered. (Dr. 
Cobb: " That does not prove it.") No, it does not, but it is a remark- 
able coincident. 

Regarding the infective theory or toxemia of Eclampsia or albumin- 
uria, certain definite pathological conditions are found as pathologists 
have proven. These are hyperemia with rupture of the capillaries, 
hemorrhage, and necrosis of the tissue; found in the kidneys, liver, 
brain, heart, lungs, and almost all organs of the body. Simple album- 
inuria, probably does not produce this pathology, but if it goes on to 
convulsions, you will find these lesions. (Schmorl.) 

I would like to recite the experiments of Von Liepmann, who took a 
normal placenta, crushed it up in a machine, dried it, and then reduced 
it to a fine gray powder. One grain of this powder was dissolved in 
salt solution, and used for intraperitoneal injections into rabbits. The 
result in nearly every case was that the animals remained very quiet for 
some time after the injection, and then recovered without untoward 
symptoms. The placentae from eclamptic patients were treated in the 
same way, and one grain injected into rabbits. The animals remained 
quiet at first, but after a few minutes they became restless, there was 
retraction of the head, in some cases tonic and clonic movements of the 
masticatory muscles were noticed, and finally the animals became com- 
atose, with the head lying loose between the fore-limbs. Death super- 
vened in most cases under twelve hours. Thus the eclamptic placenta 
contains a substance which the normal placenta does not, and this sub- 
stance is toxic to rabbits. 

Further, the placenta from a patient who has many fits is less toxic 
than one from a patient who has only had a few, which means that the 
toxin has passed out of the placenta into the system in greater quanti- 



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THE CLIN I QUE. 103 

ties in the first case than in the second. The amount of albumin in 
the urine is no guide to the severity of the case, for eclamptic convul- 
sions may occur without any albumin appearing in the urine, or even 
without any alteration of the amount of urine ex<yeted. The author 
then considers that a toxin is elaborated in the placenta in cases of 
eclampsia, and that this toxin passes into the system and then affects 
principally three organs, viz.: the .brain, liver, and kidneys. The 
liver and kidneys are two great eliminating organs respectively of the 
portal and systemic systems, and are thus readily damaged by any 
poisons, whether chemical or bacterial in origin, as is indeed seen in a 
number of infections. Further, the author suggests that the liver at- 
tempts to store and to render innocuous this toxin, and thus explains 
those cases of eclampsia, which occur after parturition; they are due to 
a reinfection from the liver. 

The liver powdered up in the same way as the placenta was proved 
to be toxic to animals, and produced death in nearly all cases. 

The brain of eclamptic patients was taken from the post mortem 
room and treated in the same way, and also injected into rabbits, but 
was found to be non-toxic; it therefore suggested itself to the author 
that the brain-substance might be able to fix the toxin, and so render 
it harmless. With a view to ascertaining whether this was so, some 
eclamptic placenta and normal brain were crushed up together, dried, 
and powdered, and injected into rabbits with the result that the eclamp- 
tic placenta was now found to be non-toxic to animals, in a similar 
way the dead fetus was crushed up and powdered and proved to be 
non-toxic to animals, thus discrediting the fetal origin of eclampsia. 

Dr. Jardine, of Glasgow, lately reports 15 consecutive cases of eclamp- 
sia treated successfully with subcutaneous injections of sodium chlo- 
ride, normal percent, and acetate of soda, 60 grains to the pint. Noth- 
ing in the world equals oxygen as an eliminator, and if you oxygenate 
the blood you will get rid of the toxines in the circulation. 

I believe with Dr. Hingston, we do have premonitory symptoms. I 
have verified Dr. Hobson's experience as to the woman who knew she 
was going to die — she knew it to such an extent that she gave away all 
her personal belongings. I did everything in the world any one could 
do as far as diet, hygiene, and internal medication was concerned. 
She went through pregnancy, was delivered two hours, when she had a 
severe post partum hemorrhage. I packed the uterus and vagina to 
control it, and gave a normal salt infusion. Two hours after that, she 
had a convulsion and never regained consciousness, and four hours 
later was dead. That was the worst case I have ever seen, and it made 



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104 THE CLIN I QUE. 

me realize what little we really can do. If a person had an absolutely 
normal physique, we would not have any of these symptoms and no 
condition of this sort arising. But either through inheritance or by 
acquisition, some people have weak organs and eliminate very poorly; 
toxines are retained, and various disorders associated with pregnancy 
arise. 

Regarding the placenta and size of the child, hypertrophy of the 
placenta is the common condition in albuminuria, which produces a 
slowing of the circulation, resulting .in improper oxydation for the 
fetus which consequently is stunted in growth. As a result, labor is 
prematurely established. Infarcts are to be found upon the placenta 
in the great majority of cases. I did not mention retinitis and it should 
have been included in the more complicated cases of albuminuria. The 
visual symptoms I referred to were the objective ones. 



SOME CLINICAL MEMORANDA. 

CLIFFORD MITCHELL, M. D., CHICAGO. 

Examine the urine of the following even though in apparent health, 
for albumin and casts: 

1. Those who have had an acute infectious disease recently. 

2. Young women about to be married, if no history of urine exam- 
ination since childhood. 

3. Middle aged men who rise at night to urinate. 

Absence of albumin a*nd casts does not necessarily exclude movable 
kidney, hydronephrosis, chronic interstitial nephritis. In chronic in- 
terstitial nephritis albumin and casts will be found by careful and repeat- 
ed testing, even if absent at times. In chronic interstitial nephritis 
albumin without casts may occur, and in arterio-sclerosis casts without 
albumin. 

In chronic interstitial nephritis a low specific gravity of the urine 
voided on rising is common and absence of casts in such urine is com- 
mon. 

Do not always rely on a single test for " albumin" in the urine. 
Albumin in large amount may appear in the urine just before or during 
convulsions of pregnancy and disappear a few hours afterwards. 

Albumin in enormous quantity may be found in cases of syphilis of 
the kidney. 

I have found a large amount of aceto-soluble albumin in the urine of 
a case of multilocular cystic kidney. 



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THE CUNIQUE. 105 

A small amount of albumin may occasionally precede the advent of 
sugar, especially in arteriosclerotic cases. 

Sugar in the urine may gradually disappear and albumin and casts 
appear in its place (Terminal nephritis in diabetes mellitus.) 

Amyloid kidney may show little in the urine which is characteristic. 
Waxy casts may appear in a variety of renal lesions but their presence 
usually signifies kidney lesion and if persistent, a chronic one. 

Fatty masses are common in subacute nephritis and may be present 
when casts are hard to find. 

In the course of an acute infection the appearance of albumin in quan- 
tity without casts or renal symptoms suggests acute interstitial nephritis. 
The cases are rare and the nephritis runs a rapid course. ' 

In cases of acute infection the appearance of casts, in number rela- 
tively large in proportion to albumin and without renal symptoms, sug- 
gests acute parenchymatous degeneration, not nephritis. The casts 
are mostly granular, and the cases mostly septic or in a jaundiced 
condition. 

In cases of choluria the presence of casts in number need not there- 
fore be construed as indicating nephritis and, if the patient recover from 
the primary disease, the casts will disappear. One of the most treach- 
erous forms of nephritis is indicated only by the urine findings: al- 
bumin, red blood corpuscles, reddish granular casts, casts with blood 
corpuscles or hematoidin. (Chronic hemorrhagic nephritis sometimes 
without edema, terminating eventually in secondary chronic intersti- 
tial nephritis). 

I have seen one case of the above which lasted eighteen years 
before death from secondary interstitial nephritis. First measles, next 
occasional renal hematuria for two or three years, apparent good health 
for thirteen years, chronic interstitial nephritis (secondary form) with 
retinitis for about two years. 

Tube casts, including waxy, have been found in the urine in cases of 
brain tumors. 

As a rule with but few exceptions in cases of nephritis the severity 
of the condition can be inferred by the number of casts on the slide. 

In pyelonephritis bacterial casts are significant. They must be dis- 
tinguished from casts which have been invaded by bacteria. A small 
amount of urea does not necessarily signify uremia. A patient who is 
gaining weight may normally show a decrease in urea. Edema is not 
necessarily a sign that albumin and casts are present in the urine. 

Presence of acetone bodies in the urine renders a one-sided diet 
dangerous for the patient even if the sugar decreases. 



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106 THE CLINIQUE. 

Sugar may be absent in the urine of diabetics at night, when the 
diet is well observed. Even with a decrease of sugar, if the patient is 
wasting the diet is not correct for the case. 

In earliest stage of diabetes mellitus, when its presence may not yet 
be suspected, the urine voided a few hours after the noon-day meal may 
contain sugar, if at no other time. 

Phosphaturia is not a sign that the patient is losing phosphorus. A 
low ratio of urea to uric acid calls for anti-lithemic treatment, but such 
a ratio is sometimes noticed in uterine and ovarian disease, which may 
require gynecological treatment. Ehrlich's diazo reaction, modified 
and properly performed, will exclude many diseases in which it is 
claimed to be found. Fat, leucin, and tyrosin require chemical tests 
for identification in some cases. 

Freshly voided urine is a desideratum for careful work, but when it 
cannot be obtained boric acid should be used for a preservative. 

In connection with cryoscopy it has been observed that polyuria may 
follow catheterization of the ureter, hence the preferable use of the seg- 
regator in such cases. 

In non-nephritic cases of renal hematuria, blood during the night 
and repose suggests tuberculosis, after exercise calculus, and at inter- 
vals, especially long ones, malignant disease. 

An increase in potassium salts over those of sodium is a sign that the 
body is consuming its own tissues. 

The last observation brings us to a consideration of diseased condi- 
tions not necessarily renal. The following is a brief fc summary of what 
to look for in the urine of many non-renal diseases. The methods em- 
ployed for the detection or the determinations, and the significance of 
the findings would occupy too much space for a journal article, but the 
list shows a field of considerable promise for those interested in modern 
analysis of urine. 

Abscess, suspected: albumoses. 

Acidosis: diacetic acid. 

Addison's disease: ratio of urea to phosphoric anhydride. 

Arteriosclerosis: albumin, casts, determination of calcium. 

Anemia: normal solids (quantitative). 

Cancer of stomach: ratio of urea to chlorides. 

Cardiac diseases: ratio of day urine to night, albumin, kind of casts. 

Carbolic acid poisoning: pyrocatechin and hydroquinone. 

Chronic diseases in general: normal solids (quantitative), special de- 
termination of chlorides (prognostic). Renal hyperemia, evidences of. 

Cystinuria: sulphur compounds. Odor. 



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THE CLINIQUE. 107 

Diabetes insipidus: volume per 24 hours, specific gravity, albumin 
and sugar, (negative). Casts, negative. 

Diabetes mellitus: if suspected, test for " assimilation limit," if 
found, diacetic acid test, acetone, ammonia determination, gray granu- 
lar casts. 

Gastric ulcer: acetone, albumoses. 

Gout or suspected arthritis: uric acid (quantity during and between 
attacks). 

Hepatic diseases: functional: " alimentary levulosuria" test, organic: 
ammonia determination, uric acid determination, tests for bile pigments y 
bile-acids, urobilin, leucin and tyrosin. Determination of neutral sul- 
phur compounds. 

Hysteria: volume of urine per 24 hours and negative tests for ab- 
normal constituents. Casts, negative. 

Intestinal diseases: indican, Rosenbach's reaction, determination of 
conjugate sulphates and conjugate glycuronates. 

Leukemia: phosphoric anhydride, uric acid, (both quantitative). 
Ratio of urea to each. 

Lithemia, so called: ratio of urea to uric acid. Sediment of urates. 

Meningitis: chlorides and phosphates (quantitative, to differentiate 
from typhoid). Albumoses. 

Malignant growths: indican, Ehrlich's diazo reaction (prognostic), 
albumoses. 

Multiple myelomata: Bence Jones* albumin. 

Neurasthenia: phosphoric acid (quantitative). Ratio of calcium to 
phosphoric anhydride. 

Osteomalacia: Bence Jones' albumin. 

Pericarditis: chlorides (quantitative). 

Pernicious anemia: color and specific gravity, determination of uric 
acid. 

Pneumonia: Determination of chlorides, phosphates, and of easily ox- 
idizable sulphur. Try also Ehrlich's " egg-yellow" reaction. 

Pregnancy; ammonia: determination in pernicious vomiting. Ace- 
tone (if dead foetus suspected). Albumin in eclampsia. Lactose when 
tests show u sugar." 

Rheumatism, acute articular: uric acid (quantitative). Urates, 
uric acid crystals. 

Scurvy in children: hemoglobin. 

Sulphonal poisoning: hematoporphyrin, (prognostic). 

Tuberculosis: Ehrlich's diazo reaction. Determination of calcium. 

Typhoid fever: Ehrlich's diazo reaction. Determination of chlorides 
(to differentiate from meningitis). 



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108 .THE CLINIQUE. 

In certain cases it may be a help in the prognosis or diagnosis to con- 
sider the significance of the following in addition to what has been 
stated above: 

Hemato-porphyrin if found in the urine of typhoid or of nervous dis- 
eases: regarded as an unfavorable prognostic sign. 

Sulphuretted hydrogen if found in the freshly voided urine: suggests 
auto-intoxication or abnormal communication between the intestine 
and the urinary tract. 

Fat in amount more than 0.175 gramme per liter of urine where ma- 
lignant disease is suspected points to the pancreas. 

Urobilin in increased amount may point to a concealed hemorrhage, 
(absorption of extra vasated blood as in ectopic gestation). 



A DAY WITH MOYNIHAN AT LEEDS.* 

GEORGE F. SHEARS, M. D. 

About 1900 knowledge came to the medical profession that some very 
excellent surgery was being done at Leeds in England, and when into 
the mass of surgical literature there came from time to time monographs 
on diseases of the stomach, the liver and the pancreas, it began to be 
recognized that not only was there some good technical work being done 
in Leeds, but that permanent additions to surgical literature were being 
made by two Leeds men, Drs. Robson and Moynihan. When then Dr. 
Macdonald and myself had done the London hospitals we felt that a 
pilgrimage to Leeds was essential to a full knowledge of what was being 
done in surgery in England today. 

A note to Dr. B. G. A. Moynihan brought a courteous response in- 
viting us to witness his operative work, and appointing a special day 
for the ceremony. The hospital at Leeds is known as the Infirmary, 
and is a large, fine building of brown brick and stone with towers and 
turrets, giving it somewhat the appearance of a modern monastery. 
Inside it is finely appointed with large, airy halls and pleasant rooms. 
One large hall is set apart for lawn tennis, for the Englishman must 
have his sport. At the head of the stairs we were met by Dr. Moyn- 
ihan, himself, a sandy complexioned, active, alert looking man of about 
forty or forty-five. From the promptness with which he appreciated 
our little jokes, and the readiness with which he returned the compli- 

* From Dr. Shears' Summer Vacation Letters. 



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THE CL1NIQUE. 109 

ments I accused him of being an Irishman, and he promptly replied: 
11 Every inch of me." 

Without loss of time he took us at once into the operating rooms, two 
finely appointed rooms with a large preparing room between them. 
Everything was up to date. Our attention was especially called to the 
matter of ventilation, one of the most sadly neglected features of most 
American operating rooms. In Dr. Moynihan's operating room the 
windows were permanently closed and the air used in the room was 
forced into it through shafts, the air passing in summer over ice and in 
winter over hot water coils and then making its entrance into the room 
through glycerated gauze. By this means the temperature of the 
operating room varied but little and all the dust and impurities were 
excluded. To be absolutely truthful, however, I must say that while 
the general temperature of the room was agreeable, this forced air would 
persist in striking the back of the neck of the unfortunate spectators if 
they stood in the position ordinarily assigned to them, and while for the 
patient all the theoretical value was obtained, for the observer there 
were some discomforts. 

The operations presented included one colotomy for cancer of the 
rectum, one gastroenterostomy for non-malignant contraction of the 
pylorus, one exploratory incision in malignant disease, two operations 
for appendicitis in the interval and one cholecystectomy. This was 
the operation for which we waited with most interest. In his work on 
diseases of the liver, both he and Dr. Robson, with whom he collabo- 
rated laid great stress upon the pulling down and turning over of the 
liver in such a way as to make the operation on the gall ducts almost 
an operation outside the abdomen. We had tried this operation many 
times and had seen others attempt it but the liver did not seem so mov- 
able as we had been led to believe from Dr. Moynihan's description. 
No sooner, however, had we seen the operation made by Dr. Moynihan 
than we recognized that one of the reasons for the imperfect turning of 
the liver was due to the fact that too short an incision had been made 
andj:hat, therefore, the liver had not been pulled down enough before 
the attempt at turning was undertaken. I have since tried the pro- 
cedure and have demonstrated the correctness of this criticism. In 
the gastroenterostomy the union was made by simple suture as is the 
general custom in England and on the continent, the stomach and in- 
testine being held in place during the suturing by Moynihan's long 
clamps. These seemed to be very useful. One long clamp holds the 
stomach and the other the intestine, the latter occluding the intestine 
both above and below the point of incision. 



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no THE CLINIQUE. 

It is hard to describe the work of the individual operator, but it may 
1>e said that for rapidity and careful attention to asepsis and technique 
this was the best work we saw in England. In opening and closing 
the abdomen the greatest care was taken. Before making the first in- 
cision the skin was lined lightly in three or four places with the knife 
across the proposed line of incision so that the exact point of introduc- 
tion of the sutures would be known to the operator when he was about 
to close the wound. When one remembers how often the edges of a 
wound are displaced during an operation this little procedure while 
simple in itself often saves much puckering of the integument. The 
incisions were uniformly made through the rectus muscle and while 
short incisions were made for exploration, uniformly large incisions 
were made in cholecystotomy, gastroenterostomy and similar oper- 
ations, the operator believing that all these operations should be done 
outside the abdomen. In closing the abdomen the peritoneum and 
fascia of the transversalis were united in one strong long iodoform liga- 
ture. This ligature without a knot was used as the return ligature to 
dose the external fascia. Silk-worm gut stitches were used at the point 
•of the lining of the integument and metal approximation stitches be- 
tween. 

It is impossible in a few words to give any idea pf the rapidity of 
-execution, the attention to details which characterized this very inter- 
esting operator. When after a most pleasant and profitable morning 
we expressed our thanks for the courtesies which had been extended to 
us this very generous reply was made : " I am very glad if I can be of 
any service to an American surgeon. I feel under deep sense of obligation 
to America. Nowhere in the world is there more surgical enthusiasm. 
If I have contributed anything that is of value to the surgical art or to 
surgical literature it is due to the inspiration which has come to me to 
a large extent through the work of the American surgeons." 



In differentiating shock and concealed hemorrhage progressiveness of 
the symptoms is very significant of continued bleeding. — American Jour- 
nal of Surgery. 

Restlessness, increasing pallor, increasing air^hunger, increasing weak- 
ness of the pulse, falling temperature (subnormal), and the ephemeral 
effect of stimulation, all point to hemorrhage rather than shock. In 
addition, there is often some local sign or symptom. — American Journal 
/>/ Surgery. 



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THE CLINIQUE. 



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gditoriat 



The Milk Supply. — The food supply of a great city is always a prob- 
lem which is difficult to regulate, important as it may be, and while it 
is natural and, in a certain sense, right to investigate and criticise from 
time to time, it is also just that our investigations shall be fair as well 
as thorough and that our criticisms shall not be extravagant unless the 
circumstances warrant it. We all know what some investigations mean 
and how prejudice may appear at any time, and we further know how 
easily a sensation may start, particularly sjiould a reporter desire a 
scoop. Then, too, it is possible to realize how easy it is sometimes to 
be overcritical if not to a slight degree unjust. Therefore it is well to 
maintain a certain amount of composure when the building is on fire, 
for the conflagration is not always as bad as it seems when the blaze is 
on. 

It is this spirit which we feel should apply in the present epidemic of 
scarlet fever and diphtheria, which is now prevailing in Chicago. We 
are not conversant with the inside facts and for that reason our judg- 
ment may be imperfect; we do know, however, that the mental state 
of a community is sometimes overwrought by exaggerated fears as to 
the cause of an epidemic; more than all during such a perturbed state 
of the public mind, it is possible to overscare the inhabitants of a city 
who depend entirely, upon newspaper reports; it is moreover possible in 
locating a cause of the epidemic not alone to be wrong but to ignore 
other and more direct causes which may pertain in certain general or 
isolated outbreaks of the fever or diphtheria. We have no desire or in- 



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H2 THE CLINIQUE. 

tention to criticise any one in this regard, but to caution people about 
running away from one epidemic with the possibility of meeting a 
worse exposure away from home. We have the highest regard for the 
efforts of any locality or state board which investigates and isolates any- 
direct or contributory distribution of infection. We cannot make a 
mistake when we applaud and support such boards for we all know how 
natural it is to criticise them. Doctors are always praised when they 
do well, but they are more thoroughly censured when they do not 
please or fail in their efforts; boards of health come under this category' 
and so we say our sympathy is with them always. One unfortunate 
thing is the fact that the public opinion is not usually obtained from 
physicians or from boards of health, but rather from newspapers; and 
we have seen the time when the newspaper reporter has been wrong, 
though his influence is mighty. 

In this particular epidemic of scarlet fever the public officers charged 
with safeguarding our health have closed one dairy supplying milk to 
the worst area of infection, apparently because it seemed reasonable to 
them that the distribution might come from this source. Scarlet fever 
had appeared in this neighborhood and the analogy was natural. No 
criticism should be offered on this account, and no milk company has 
the right to object to such precaution; the worst phase is that this par- 
ticular company may be charged by the public, through the newspaper 
reports, with wanton carelessness and neglect, which certainly is not 
the case in this instance; there is no company of the kind which has 
done more for the public good in this respect than the one under sus- 
picion; its specialty has been cleanliness and purity, and this has been evi- 
dent in its various dairies, inside and outside, from one part of the coun- 
try to the other. No one has appreciated this more than the physician, 
and for that reason it is natural for us to protect the good name of a 
company which has been unfortunate in this instance which might 
have come to any one. As we said before, if we scare the people too 
much about a local epidemic, we may drive them out of town into one 
that is worse; and we may further say that it is possible to unjustly 
frighten people away from a reliable milk dealer only to choose a worse 
one which, unfortunately, has not been discovered in error. There- 
fore, on general principles alone we stand by the firm which has for a 
long time made an attempt at purity. To show how careful this com- 
pany has been we learn that in a case of suspected infectious disease 
this company offers to pay the farmer full price not to bring milk to 
their dairy, which is probably not true with any other company. Thus, 
we feel for the sake of our patients, as well as for justice, we should say 



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THE CLINIQUE. 1 13 

what we have. By all means, however, let these investigations go cm; 
they are bound to do good as publicity is always a good thing, and we 
are moving very fast in that regard in the present age. 

But we started out to say something on the general subject of our 
food supply in which milk is of course included; it is to the effect that 
we have made great strides in our protection against impurities and we 
often fail to appreciate it; the stage of perfection is not yet reached but 
it is much nearer and all we want is more individual honesty every- 
where and then it may at last pervade the food depot. It is not law 
alone that will do this for that is obeyed only through fear and that 
quality often suffers serious lapses; we must sometime have a revival 
of honesty and then this must again be adopted as the best policy; 
when people really find out that this pays best it may become an indi- 
vidual and possibly a corporate procedure. In the meantime let us go 
ahead patiently to do all we can and the best we can to encourage the 
millennium to hurry up and get here. Milk and food are not alone dan- 
gers in themselves but because they are mediums of transmission; and 
that is where the fault invariably lies; it is not the innate cussedness we 
fear most; it is the clandestine distribution of the same which causes a 
disturbance; so long as a man will keep his meanness to himself there 
is little fear but when he spreads it abroad we all suffer. Let us not 
bother onrselves alone about our impure food but let us go into the 
kitchen and see who cooks it, how it is cooked and who serves it and 
how he serves it. Some day our inspectors may cover more than the 
food we eat and the means of distributing it; they may even consider 
the fellow who eats it and how he does it. 

And still we are making progress all the time; don't let's throw 
stones at the first delinquent; rather let us compare the past with the 
present and go ahead with courage. We recently learned something 
about our slaughter houses and a reform was started; here is work for 
us to see that it is kept up, but let us at all times be just. We have 
our new food bill and this is a great step in the advance; but we trust 
it will not work unjustly. One thing is certainly true and that is if the 
dairies which supply our city with milk are to be investigated at all, 
that work should be done before rather than after an epidemic. There 
is always a possibility of going ahead too fast for it is unpleasant to side- 
step later on. Just at present there is possibly too much meddling by 
the national and state governments for the just may perchance be in- 
cluded with the unjust and by no means do we wish to spoil a good in- 
tention if it anywhere exists. And furthermore all of these subjects 
are of vital interest for physicians for we are good Samaritans among 
our people. h. v. h. 



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ii4 THE CLINIQUE. 

Immigration and Health. — The subject of immigration has for many 
years been a troublesome one for the politicians ; not that it has ever 
been difficult to decide what was best for our country as much as it was 
to discover what was best for the congressman's fence ; when a question 
between right and wrong must be settled it is never difficult to make 
an honest decision, but when the votes are to be counted it is a different 
matter particularly with the fellow who seeks re-election. For this 
reason alone no definite or satisfactory restriction has been made by 
our laws which govern immigration, though no honest person will deny 
that our present laws need thorough revision in this respect. This 
country has always been and always will be the goal for the oppressed 
and the homeseeker who desires a better opportunity in life ; we shall 
never turn back from our shores the honest man of any rank who 
desires to be one with us, to partake of our civilization and to become 
an upright and worthy citizen. The best of our blood and our sinew is 
cosmopolitan and we can never deny our foreign ancestry. This wel- 
come spirit however should never be so literally interpreted that we 
shall take or endure all that comes to us ; our body politic and our 
national life, to say nothing of our domestic rights, can never tolerate 
the reception of an emigrant foul in body, mind and heart, and for that 
reason rigid inspection in this regard is a national necessity. No 
foreign country has the moral right to send us her outcasts, her crimi- 
nal or her diseased subjects and our communal rights at once rebel at 
this. To the worthy we have always extended the right hand of fellow- 
ship, but to the unworthy we must present the barrier of restriction. 
Unless the immigrant comes to partake of our blessings, to enjoy our 
life and to obey our laws we must forbid his entrance. Neither is it 
just that we should accept the germs of disease or the incapacitated who 
are bound to be a public charge. Great as our charity and our philan- 
thropy may be, our own health and our own existence must be protected 
and preserved. 

Our recent immigration has surpassed expectation numerically; this 
however is not the worst feature for it has been clearly shown that the 
physical and mental qualities of the aliens we are now receiving are 
much below that of those who came in former years; our largest num- 
ber of aliens now come from those countries in which the standard of 
living is lowest and for that reason we are receiving a class who are 
least desirable and, worst of all, this change of abode is evidently de- 
sired by those countries and encouraged, particularly by the steamship 
lines for the sake of monetary considerations. These at once become 
a charge upon our hands and from their tendency to locate and live in 



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THE CLINIQUE. 115 

c z r 
our already congested centres they furthermore become a menace to 
our public health. People physically debilitated andaccustomed to un- 
clean methods of living are always prolific subjects to disease, to say 
nothing of the physical- infirmity which they bring to our overcrowded 
cities. Therefore in the study and application of our problem of im- 
migration there is something more to consider than the numerical in- 
crease of our population and the overcrowding of the labor market. We 
have state and national regulations to safeguard our health and it certainly 
is a just requirement to protect ourselves at our ports of entry. Let any- 
one go through the wards of our city hospitals and see how the foreign 
element predominates and it will be readily seen how much of our dis- 
ease comes from abroad. Our statesmen must sometime rise above 
the expediency of politics and give a conclusive demonstration that 
health, habits and character are essentials to be considered in our im- 
migration as well as the money requirement for self support. f 

Dr. George F. Adams, in a recent article in the Medical Century, 
gives some very pungent thoughts relative to insanity and immigration; 
we quote only a few and yet suggestive remarks from this paper. 
" When we consider the large number of insane that Great Britain and 
Ireland, Germany and Scandinavia have given us, and the immigrants 
from these nations make the stable, solid, desirable citizens in this 
country, what have we a right to expect in a few years from the hordes 
that are entering our ports^from south Europe? The Italian, the Hun- 
garian and the Slav have been with us too short a time for us to gather 
reliable statistics of their mental instability. What has the future in 
store for our country? From the view point of the alienist, immigration 
has a most important bearing on the increase of insanity, and with a 
two to one increase it is placing a burden upon us that we should avoid, 
if possible. It would seem to me that all physicians should bring to 
bear on their representatives in Congress and their, United States Sena- 
tors this view of the case, and try to have a reasonable and just regula- 
tion of immigration established. We may be reaping the wind at the 
rate of a million a year, and our children will gather in the whirlwind. " 

h. v. H. 



The Local Option Question.— The local option issue has assumed new 
life of late, though this has always been a burning question with spas- 
modic accentuation at different seasons. That it is a proposition difficult 
of settlement cannot be denied; men are prone to wax eloquent on this 
subject when the reform favors their own neighborhood, but when it in- 



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n6 THE CLINIQUE. 

fringes upon their own personal rights or possibly a pecuniary consid- 
eration they are liable to squirm with excuses; for some unexplainable 
reason men, even of good standing, like a free rein in this regard. 
Only recently we have the object lesson of a certain protective associa- 
tion, which is supported by the people of a prohibition district, having 
to deal with a social club composed of those same people who wanted bar 
privileges for their club in the same district; and as Mr. Dooley says 
" there you are;" what is good on one side of the street is not always 
desired on the other, and people are known to differ with their own 
ideas of right when a glass of liquor is at stake. 

Local option is in no sense a new idea; all the true theories of home 
life are centered in this; if we have not home rule, then home life is 
perverted; if we cannot have this and cannot move, what then are we 
to do ? ' It should be the privilege of every community to legislate for 
its individual rights, and this principle must always be safeguarded or 
our civic life is doomed. The Anti-Saloon League may possibly be a 
little too strenuous for the liquor interests and for the " personal lib- 
erty " people, but in reality what is wrong with their aim? No one is 
brave enough to claim that the liquor traffic is right, and if it is not 
right, why should we defend it against the best interests of our home 
environment? If we cannot keep the saloon from our residence district 
what incentive is there to build homes and to keep them pure and un- 
defiled for our children? If it is a matter of making money in prefer- 
ence to making happy homes, why not become nomads and give up the 
idea of a settled community ? On the contrary if any community should 
desire to be free from this nuisance why should not the tippling ele- 
ment of that vicinity betake themselves to the locality where a saloon 
is desired? These questions may not appear to be pertinent to some, 
and yet they are asked with due respect for those who prefer drunken- 
ness to sobriety. 

We cannot see anything wrong or unfair in the features of the bill 
which is now before our legislature for it only stands for the following 
self-evident rights: The bill provides for the creation by popular vote 
of anti-saloon territory within which the sale of intoxicating liquors 
and the licensing of the same shall be prohibited and the voting on 
anti-saloon propositions is to be done at regular elections. We are 
not now discussing the right and wrong of the liquor question for that 
deserves an editorial by itself. We only call our readers' attention to 
this question regarding local rights. We also suggest that it would be 
a good idea for every one to watch this bill in our legislature and to 
see how the vote stands. H# v# H 



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J 



THE CLINIQUE. 117 

j&orieties. 



CHICAGO HOMEOPATHIC MEDICAL SOCIETY. 

secretary's report. 

The 103rd regular meeting of the Chicago Homeopathic Medical So- 
ciety was held at the Northwestern University Building, Jan. 17, 1907. 
The meeting was called to order by the President at 8:30 p. m. The 
minutes of the previous meeting were read and approved. The Medico- 
Legal Committee presented a bill from the Chicago Medical Society for 
$100.00 our share in the expense of the affiliated committee's and at- 
torney's fees for the two societies. The bill was ordered paid. The 
bills of the society for printing, postage, rent, stenographer, etc., 
amounting to about $21.00 were ordered paid. 

Upon approval of the Board of Censors, the five applications for 
membership were accepted. Those were Drs. F. A. Metcalf , Annie H. 
White, L. C. Hatton, Robt. E. Graves, and E. J. Abbott. The two 
resignations of Drs. H. E. Kersch and W. F. White were accepted with 
regret. 

Upon motion of Dr. Haseltine the chair appointed a committee to 
arrange a dinner for Dr. E. B. Hooker, of Hartford, Conn., president 
of the American Institute, and delegated Dr. Cobb to invite. Dr. Hooker 
to be the guest at this dinner of the homeopathic physicians of Chicago. 

Notice was given by Dr. Tenney, on behalf of the committee, that 
the work of revising our constitution to meet the requirements of asso- 
ciating the various homeopathic societies in Chicago was completed, 
and this constitution was placed in the secretary's keeping for the in- 
spection of any of the societies' members. 

The program of the meeting was on the special topic of the Albumi- 
nuria of Pregnancy, a report of which will be found in this number. 
Dr. Fitz-Patrick presented a short paper, which was to have been fol- 
lowed by one from Dr. A. P. Hedges, who was not present. The dis- 
cussion was opened by Drs. E. M. Bruce and Clifford Mitchell for the 
renal diseases. Drs. E. S. Bailey and Sarah Hobson for the general 
phases and preventive measures. Dr. J. W. Hingston for the home- 
opathic remedies. Dr. J. P. Cobb for the effect on the child. Dr. B. 
D. Haseltine for the eye manifestations. Dr. Frank Wieland related a 
scientific incident. Dr. Fitz-Patrick closed the discussion. 

The meeting adjourned at 10:45 p. m. 

Frank Wieland, Pres. 
George McBean, Secy. 



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n8 THE CLIMIQUE. 

THE CLINICAL SOCIETY OF HAHNEMANN COLLEGE. 

A meeting of the Clinical Society of Hahnemann College and Hospi- 
tal was held Monday evening, December 3d, in the amphitheatre, in 
lieu of the regular meeting which should have been held November 
26th. The vice president, Dr. E. L. Hunter, presided. About fifty 
physicians were present. 

Dr. C. D. Collins presented a case of dermatitis in a patient aged 23 
years, beginning with an injury to the right hand ten months ago, 
which was slow in healing. Yielding to the continued suggestions 
that it was syphilitic, the young man took massive doses of " the three 
S's " taking two tablespoonfuls q. i. d. The lesions presented a defi- 
nite circular outline, elevated, and were bilateral. The treatment ad- 
vised was discontinuance of the use of " S. S. S."; a protecting and 
slightly antiseptic local application was advocated, such as ichthyol 
10 % cerate and rhus tox. internally. 

The next patient, aged 18 years presented a classical history and 
symptoms of pemphigus vulgaris, the first eruption appearing between 
the 2d and 3d year, on the hands, in the form of blisters, in time attack- 
ing the elbows and shins. There were no lesions on mucous mem- 
branes. The nails had disappeared from hands and toes. The cause 
was probably an inherited lowered vitality. Along the line of treat- 
ment, nutritious diet was advised to aid in raising the vitality, not too 
much exercise and hard work, good habits. Dr. Collins considered the 
most effective local treatment to be a prolonged medicated bath in 
which all the parts shall be immersed from one-half to one hour daily, as 
for instance normal salt solution and formaldehyde. The blisters should 
be opened as soon as formed, without waiting to dissect a large area of 
skin. The tissue remedies always help these cases; arsenicum, china and 
others are to be thought of. Red bone marrow does much to build up 

the system. 

Dr. Max Hubeney presented a specimen of testicle and cord which Dr. 
Geo. F. Shears had removed from a man of twenty-four years of age. The 
testicle in this case had never descended and as is common in most 
of these instances a large hernia was present. While operating for the 
hernia the testicle was found behind the perineum and up as high as 
the superior spine. An attempt was made to bring it down into the 
scrotum and the different retaining fibers were divided, including the 
veins of the cord in an attempt to give greater freedom to the testicle. 
Upon further examination, however, it was found that the vas defer- 
ens was not connected with the testicle, terminating a short distance 
from it in a closed tube. The testicle could not, therefore, be func- 



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THE CLINIQUE. 119 

• tionally active. The cord was found in the inguinal canal and de- 
scended as far as the pubis, at which point it turned upon itself and 
again entered the inguinal canal. 

In his remarks at the time of operation Dr. Shears said that he found 
the arrested testicle all the way from the lumbar region to the external 
abdominal ring. That as a rule it was smaller than the ordinary testi- 
cle and might or might not be active functionally. When lodged in 
the canal it was often subject to attacks of orchitis from pressure and 
was also more liable to carcinomatous degeneration than the normal 
organ. For some reason which he was unable to explain the right tes- 
ticle was more frequently retained than the left. 

In regard to treatment he always made an attempt to get the gland 
into tjie scrotum and fasten it there, but truth compelled him to say 
that the organ would not always remain in the place in which it was put 
and that.it was often the source of inconvenience and distress. Taking 
this into consideration and the fact that occasionally as in the case 
herein presented the organ was not functionally active, that unless the 
organ could be easily placed in the scrotum he believed its removal with 
complete closure of the inguinal canal gave the patient the best chance 
for comfortable existence. 

Dr. Hunter introduced the speaker of the evening, Mr. S. G. Pandit, 
a high-caste Brahmin graduate of the University of Bombay, India, who 
gave a very interesting and instructive comparison of Oriental and 
Western medical practice. In dwelling upon the general principles 
which underlie every method, Mr. Pandit said: "One thing character- 
istic of the science of health and medicine as practiced in India which 
distinguishes it as practiced in Western countries whether Europe or 
America is, I think, that in India they look at principles first and then 
go to details; they take a view of the whole and then study the relation 
of the parts to each other, instead of specializing too much and taking 
one particular organ and body and learning all about it. This is also 
true in philosophy, metaphysics and science. Always begin with the 
general as a whole, then break it up into three to five divisions, each 
of which ia still further subdivided into its innumerable parts." In 
presenting his subject, Mr. Pandit followed this plan, citing methods 
adopted in acquiring control of the sympathetic nervous system and in- 
voluntary organs, as the heart and lungs, and finally presenting the 
methods followed in treating mental and nervous disorders. He also 
emphasized the three-fold aspect of man, the mental, emotional or 
passional, and the" physical, illustrating their respective relations to 
and reactions upon one another. 



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120 THE CUNIQUE. 

The discussion, lead by Dr. Katherine Clapp, brought out many in- 
teresting points, especially regarding the plague and cholera in their 
seeming preference of attack on the natives of India and the visiting 
Americans or Europeans. 

Dr. Hunter thanked Dr. A. C. Tenney, in behalf of those pres- 
ent, for securing so acceptable a speaker as Mr. Pandit proved to be. 

Acting upon the suggestion of the Organization Committee of .the 
State Society presented at our previous meeting by Dr. Tenney, the 
Clinical Society endeavored to send notices of this meeting to the mem- 
bers of the other societies. The attendance was representative as well 
as enthusiastic. 

The meeting adjourned at 10:10 p. m. 

Christine Bergoi/th, M. D., Sec. 



COLORADO HOMEOPATHIC SOCIETY. 

The Colorado Homeopathic Society recently held its twenty-first an- 
nual meeting in Denver. A full program was presented. The papers 
all showed deep thought and a wide range of reading in their prepara- 
tion. The following officers were elected for the ensuing year: 

President — Dr. F. A. Faust, Colorado Springs; 1st Vice President — 
Dr. A. C. Stewart, Denver; 2nd Vice President — Dr. Clinton Enos, 
Denver; Secretary — Dr. E. B. Swerdfeger, Denver; Treasurer — Dr. J. 
B. Brown, Denver. Board of Censors — Drs. A. C. Stewart, W. C. 
Allen; W. A. Burr, E. P. Greene, J. B. Kingsley, W. J. King; Admin- 
istrative Council — Drs. W. J. King, E. A. Darby, J. B. Brown, S. L. 
Blair, J. P. Willard, E. P. Greene, W. C. Allen. 

We are going to depart from the time of meeting by holding our next- 
meeting in Denver early in the spring. The finances are in such ex- 
cellent shape that we were enabled to donate $50.00 in 1905 to the in- 
terest of drug proving. In 1906 we gave $75.00 to the Park Avenue 
Hospital and still have a nice sum in the treasury. 

E. B. Swerdfeger, M. D., Secretary. 



In post-operative collapse if, after studying the symptoms, there be 
any doubt whether the condition be due to shock or to concealed hem- 
orrhage, the wound should be opened and bleeding sought for. — Ameri- 
can Journal of Surgery. 



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THE CLItilQUE. 121 



The Etiology of Eclampsia. — The yournal of Surgery, Gyne- 
cology and Obstetrics has translated the following from Von Liepmann's 
interesting series of experiments performed with a view to determining 
the etiological factor in eclampsia, and they have considerable bearing 
on the treatment of that condition. He took a normal placenta, crushed 
it up in a machine, dried it, and then reduced it to a fine gray powder. 
One grain of this powder was dissolved in a salt solution, and used for 
intraperitoneal injections into rabbits. The result in nearly every case 
was that the animals remained very quiet for some time after the injec- 
tion, and then recovered without untoward symptoms. The placenta 
from eclamptic patients were treated in the same way, and one grain in- 
jected into rabbits. 

The animals remained quiet at first, but after a few minutes they be- 
came restless, there was retraction of the head, in some cases tonic and 
clonic movements of the masticatory muscles were noticed and finally 
the animals became comatose, with the head lying loose between the 
fore-limbs. Death supervened in most cases under twelve hours. Thus 
the eclamptic placenta contains a substance which the normal placenta 
does not, and this substance is toxic to rabbits. 

Further, the placenta from a patient who has had many fits is less toxic 
than one from a patient who has only had a few, which means that the 
toxin has passed out of the placenta into the system in greater quantities 
in the first case than in the second. The amount of albumin in the urine 
is no guide to the severity of the case, for eclamptic convulsions may 
occur without any albumin- appearing in the urine, or even without any 
alteration in the amount of urine excreted. The author then considers 
that a toxin is elaborated in the placenta in case of eclampsia, and 
this toxin passes into the system and then affects principally three organs 
viz. The brain, liver, and kidneys. The liver and kidneys are two 
great eliminating organs readily damaged by any poisons, whether 
chemical or bacterial in origin, as is indeed seen in a number of infections. 
Further, the author suggests that the liver attempts to store and to ren- 
der innocuous this toxin, and thus explains those cases of eclampsia which 
occur after parturition; they are due to a re-infection from the liver. 

The liver powdered up in the same way as the placenta was proved 
to be toxic to animals and produced death in nearly all cases. 

The brain of eclamptic patients was taken from the postmortem room 
and treated in the same way, and also injected into rabbits, but was found 
to be non-toxic; it therefore suggested itself to the author that the brain- 
substance might be able to fix the toxin and so render it harmless. With 
a view to ascertaining whether this was so, some eclamptic placenta and 
normal brain were crushed together, dried and powdered and injected 
into rabbits, with the result that the eclamptic placenta was now found 
to be non-toxic to the animals. These experiments are still being more 
fully investigated. In a similar way the dead fetus was crushed up and 



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122 THE CLINIQUE. 

powdered and proved to be non-toxic to animals, thus discrediting the 
fetal origin of eclampsia. 

Five years ago Professor Bumm, in Berlin prophesied that if the uterus 
were at once emptied as soon as the patient had a fit, the then existing- 
mortality of 30% might be reduced to 5 %. 

The author therefore gives figures to show that in Berlin and Halle r 
where during the last five years immediate induction of labor has been 
performed in all cases of eclampsia, the mortality has been reduced to 2- 
8 per cent, and if the last seventy-nine cases treated in Berlin alone are 
taken into account, it has further been reduced to 1.9 per cent, thus ex- 
ceeding the great reduction prophesied by Bumm. It is therefore urged 
that the only treatment of eclampsia is to induce labor as soon as possible, 
and at whatever cost must the uterus be emptied and the placenta 
removed. g. f. p. 

Pneumonic Fever. Open-Air Treatment. — Northrup details 
his experience of eleven years at the Presbyterian hospital, New York, 
with the cool, fresh air treatment of pneumonic fever, during the last 
year of which period he has practiced the open air method exclusively,, 
and in all weather the only«ejcceptions being "high, harsh winds, rain 
and snow. These measures were not adopted without much observa- 
tion, precaution and watching, and resulting in a firm conviction that 
patients so treated were decidedly benefited. A study of a number of 
cases in support of this practice is included in the article which is sum- 
marized thus: 

" 1. The cases most favorably affected by open-air treatment are those 
with severe poisoning, with delirium, partial cyanosis or deep stupor 
('dopey'). In my experience all cases fare better in cool fresh air. 
Open air may be secured by screening off the bed and a portion of the 
room next to the window. 

" 2. In my experience no cases of pneumonia have been injured, and 
a few have been much aided, possibly saved, by the cold fresh-air treat- 
ment. 

"3. If pneumonia due to an infecting agency is benefited by the 
treatment, one may be easily led to try it for other infectious diseases. 
As a matter of fact I have tried it for many others, including typhoid 
with severe bronchitis, whooping cough with bronchitis and convul- 
sions, with excellent results. It seems to me the ideal treatment for 
all forms of ( septic fever. ' 

" 4. The only regulation is to make the patients comfortable, keep- 
ing their feet warm especially. The ears, nose and hands may get cold 
without harm. 

" Finally — The Presbyterian Hospital is so convinced of the perma- 
nent usefulness of open-air treatment for all infectious fevers, that it 
has built a roof garden for the children's ward, and is about to build on 
the main roof of the medical side of the hospital a colossal roof garden. 
One-half of this has a " horse shed" structure, the shed open to the 
south, and a liberal space in front, enclosed, like a paddock, for a roof 
garden. In bad weather the beds of the fever patients are to be wheeled 



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THE CLINIQUE. 125 

back into the depths of the shed. In good weather they will be ad- 
vanced more and more to the opening, or even out into the garden. 
They will remain there night and day, so long as their fever is high* 
It is to be an open-air ward." G. 1,. B. 

Uses of Perhydrol in Dentistry. — Good results were obtained 
by M. Kritchewsky in fully a dozen cases of pyorrhea alveolaris with 
perhydrol (30 per cent, hydrogen peroxide). The roots of the teeth 
were carefully brushed and pure perhydrol applied with a cotton carrier, 
to the gingival sacs. After the first treatment the violet color of the 
gums disappeared, the gums became more firm, and the pain diminish- 
ed. In 13 cases of caries of the fourth degree there was not one failure. 
If a fistula were present, it usually closed after the first application. 
The canal was first carefully cleaned to the apex and down to the fistula, 
if present, and perhydrol was then applied with a cotton carrier. Even 
if there is no fistula, it is advisable to make the application beyond the 
apex of the tooth. For bleaching teeth, perhydrol has given better 
results than all other preparations. — I/Odontologie, April 15, 1906. 

Paranephrin in Coryza and as a Prophylactic. — K. Vohsen, 
of Frankfurt a. M., states that pathological conditions of the nose and 
of the nasopharynx undoubtedly signify an increased danger for acquir- 
ing cerebrospinal meningitis. A careful examination and treatment of 
the upper air passages in children, is, therefore, indicated. In the 
coryza of infants and young children, the chief symptoms are not due 
to the increased secretion, but to the difficulty in getting rid of the 
secretion, owing to the swelling of the mucous membrane. 

In adults, the following solution has given considerable relief: 

Cocain, Hydrochlor 1 (15 grn. ) 

Paranephrin 2 (30 min. ) 

Aqua Dest 20 (5 drams. ) 

In an uncomplicated coryza, a few drops of this solution will enable 
the patient to breathe through the nose for hours. The best way of 
applying is by means of a cotton applicator. Paranephrin is preferred 
to the other suprarenal preparations since it is absolutely free from all 
caustic action. — Excerpta medica, 1906> No. 5. 

Asthma. Electrical Treatment. — The Medical Review pub- 
lishes an article outlining the following electrical treatment of asthma. 
This applies more particularly to the care of the essential form rather 
cardiac asthma which is seldom relieved by these measures. It con- 
sists in galvanization of the cervical part of the vagus. The active 
pole formed of a circular carbone pad 2% in. in width, covered with 
chamois skin, and moistened in warm, clear water is placed first on the 
midlateral part of the neck, and then on the lower attachments of the 
sterno-mastoid muscle. The indifferent pole consisting of a 3x6 in. 
plate, chamois covered and moistened is placed on the nape of the neck, 
or in the case of tuberculous, pseudo-asthma, over the lung apex. A 
current of 10 to 15 ma continued for 10 to 15 minutes is repeated two 
or three times a week. G. l. b 



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124 THE CLINIQUE. 

Scroll itetmms. 



Thb Test Drug-Proving of thb O. O. & L» Society. — A Re- 
Proving of Belladonna; being an experimental study of the patho- 
genic action of that drug upon the healthy human organism. Con- 
ducted under the auspices of the American Homeopathic Ophthal- 
mological, Otological and Laryngological Society, with the indorse- 
ment and co-operation of the American Institute of Homeopathy and 
various State and Local societies. Arranged and condensed by the 
general director of the proving, Howard P. Bellows, M. S., M. D., 
Professor of Otology and formerly Professor of Physiology in the 
Boston University School of Medicine. 675 pages, with illustrations. 
Boston. Published by the O. O. & L. Society, 1906. The Univer- 
sity Press, Cambridge. 

That our homeopathic drugs should be re-tested, no thinking medical 
man can doubt. Many of the terms used in the old nomenclature are 
obsolete, and to us of the younger generation they may be even absurd. 
The symptoms recorded in regard to special organs convey little mean- 
ing of the actual pathologic condition present, for the old tests were 
made before the modern instruments of precision were dreamed of, and 
before the days of differential diagnosis. The only specialty in those 
days was surgery, which had recently graduated from the hands of the 
barber to those of the physician. So the old tests are of little value to 
the specialist of today and still less to the exclusivist. More than this, 
our books on Materia Medica contain symptoms galore that were never 
produced by tests on the healthy human body, but are clinical symptoms 
obtained from cures of diseased bodies, and are jumbled in helter-skelter 
with the true drug symptoms, to our utter confusion. It certainly is 
folly to prescribe a drug in the higher potencies for the relief of symp- 
toms, which were never produced by that drug, but only relieved by it 
in appreciable doses at some remote time, and so recorded. Surely that 
is not si m ilia. 

A recently published book on Homeopathic Materia Medica contains 
over 1000 drugs, of which certainly less than 500 have ever been tested 
according to Hahnemann's method, and therefore only a minority of 
them can be used homeopathically. 

The work of the O. O. and L. Society in testing Belladonna, and 
publishing the results obtained, is colossal, almost incomprehensible 
there is nothing left to be said, or done in Belladonna experiments. The 
only question which forces itself into our minds whenever we see this 



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THE CLINIQUE. 125 

fine book is, " how many years must we wait for even- our poly ch rests 
if this enormous labor represents only one drug?" 

No one can imagine the amount of work done, until he is forced to 
face it, as many of our men are doing now in the new proving undertaken 
this year. It is to be hoped however that the next publication will be 
a smaller, less expensive book, one which may obtain a wider circulation 
and may require much less leisure time for study, with possibly a 
chapter devoted to key-note symptoms and suggestions in special indi- 
cations for diseased conditions as related to the pathology produced by 
the drug. g. m. mc b. 

Plaster of Paris and How to Use It. — By Martin W. Ware, M. D., 
Adjunct Attending Surgeon, Mount Sinai Hospital; Surgeon to the 
Good Samaritan Dispensary; Instructor in Surgery, N. Y. Post 
Graduate Medical School, nmo; 72 illustrations, about 100 pages. 
Surgery Publishing Co., 92 Williams St. N. Y. City. Cloth, $1.00. 

This is one of the most useful books ever presented, not only on ac- 
count of the general demand for the information and instructions upon 
the subject which this book so explicitly, practically and comprehensive- 
ly covers, but because this knowledge was not previously available 
except from such a vast experience as enjoyed by Dr. Ware, or, in part, 
by reference to many books on allied subjects. 

It is a vivid narrative, profusely illustrated, of the many uses to which 
Plaster of Paris is adaptable in Surgery. The whole subject, from the 
making of the Bandage to its use as a support in every form of splint, 
corset or dressing, is graphically described and illustrated. The use of 
Plaster of Paris in Dental Surgery is also covered. The book is pre- 
sented in the artistic manner characteristic of the productions of the 
Surgery Publishing Company. It is printed upon coated book paper 
and attractively bound in heavy red buckram, stamped in white leaf and 
gold. Price $1.00. 



A Text-Book of Pathology. By Alfred Stengel, M. D., Professor 
of Clinical Medicine in the University of Pennsylvania. Fifth Revised 
Edition. Octavo of 977 pages, with 399 text illustrations, many in 
colors, and 7 full-page colored plates. Philadelphia and London: 
W. B. Saunders Company, 1906. Cloth, $5.00 net; Half Morocco, 
$6.00 net. 

Of a book that has entered its fifth revised edition, little new can be 
said. Stengel's Pathology is recognized by all as" authoritative. The 
present edition is very attractive in form and shows considerable recon- 
struction, bringing it up to the latest accepted knowledge on this subject. 



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126 THE CLINIQUE. 

Jl Manual of Normal Histology and Organography. — By Charles 
Hill, Ph. D., M. D., Assistant Professor of Histology and Embryol- 
ogy, Northwestern University Medical School, Chicago. i2mo 
volume of 463 pages with 312 illustrations. Philadelphia and London: 
W. B. Saunders Company, 1906. Flexible leather, $2.00 net. 

This book is very* desirable for use by the busy man or student. 
Profusely illustrated, with clear concise text, it certainly meets a need for 
such a book on Histology. The chapter on teeth is especially complete 
and interesting. 



'Tuberculosis. — Six lectures upon the different phases of tuberculosis, 
delivered in the University of Michigan. Published by the University 
Homeopathic Observer, Lancaster, Pa. 

The contributors to this little volume are Dr. W. B. Hinsdale, Dr. 
W. A. Dewey, Dr. R. S. Copeland, Dr. C. B. Kinyon, Dr. D. T. 
Smith and Dr. C. A. Burrett, all connected with the University. The 
lectures are worthy of their authors and a credit to the homeopathic 
profession. 



Biennial Report of the Department of Health of the City 
of Chicago, for the Years 1904-1905. Charles J. Whalen, M. 
D., Commissioner of Health. 

In view of the scarlet fever epidemic from which the city is just 
•emerging, this report contains much of interest to physicians. Especial- 
ly worthy of perusal is the chapter on vital statistics. 



A pulsating swelling in the midline of the abdomen should not be too 
•quickly accepted as an aneurism of the aorta. It may be a retroperi- 
toneal tumor. — American Journal of Surgery. 



Before operating for sarcoma examine the lungs carefully. Do not 
operate if the patient has persistent cough and blood-stained sputum (not 
due to tuberculosis ), even though no definite signs are found in the lungs 
— a metastasis has developed. — American Journal of Surgery. 



Is cases of chronic appendicitis, if an examination be conducted with 
the patient in a hot bath (105 F.), the thickened appendix may often 
-be felt to roll under the finger. — American "Journal of Surgery. 



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THE CLINIQUE. 127 

jetors Items and personals. 



Members of the profession axe earnestly solicited to send in items of news regularly. 
A call at the editorial offloe is always welcomed. 

Dr. D. M. Lines formerly at New Orleans, La„ has located in Tam- 
pico, Mexico. 

Dr. A. M. Cameron has resumed practice after a trip to Texas follow- 
a siege with pneumonia. 

Dr. M. J. Moth has opened an office in suite 1008 Reliance Building, 
Chicago. Hours 3 to 5 p. m. Phone Central 4639. 

Married. — Dr. A. E. Com stock, Hahnemann '99, and Miss Minnesota 
Berkley, February 8, 1907, at St. Paul, Minnesota. 

Dr. F. W. Rutledge, Grand Forks. N. D., died on Sunday, Feb. 3d. 
This leaves a good opening for a first class homeopath. 

A good location in central Illinois. 1 will abandon a good practice to 
go into special work. Address, L. care of Clin i que. 

Dr. Edith C. Wells has removed her office to 1800 Buchanan street, 
corner Sutter. Phone, West 424. San Francisco, Cal. 

There are several large towns in southern Illinois with no homeopathic 
physician where practitioners of our school would be welcomed. 

Dr. W. C. Roberts, of Hahnemann's last graduating class, began his 
service in the Metropolitan HospitaPof New York on January 1st. 

For Sale — My practice and office furnishings at a bargain for cash. 
Immediate possession given. Address, Dr. L. F. Hazelton, Baraboo, 
Wis. 

Dr. Robert Moth, who practiced for a time with his father, Dr. M.J. 
Moth of Chicago, is now located in New Orleans and it is his belief that 
any homeopath looking for an opening does well to try the south. 

The transactions of the Homeopathic Medical Society of the state of 
Pennyslvania, for 1906 has just appeared. The volume is a beautiful 
one and contains much material worthy to be preserved in permanent 
iorm. 

Dr. I. O. Denman of Charleston, III., is taking special work in Chi- 
cago on the eye, ear, and throat. Dr. Denman is president of the East- 
ern Illinois Homeopathic Medical Society which holds its next meeting 
at Charleston in April., 



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128 THE CLINIQUE. 

E. C. Rice, dentist, writes from Sauk Centre, Minn., that Dn A. W. 
Cummings their only homeopathic physician, who practiced in Sauk 
Centre 15 or 20 years, died recently and leaves a most excellent opening 
for a good practical homeopathic practitioner. 1 

Dr. Edward Beecher Hooker of Hartford, Conn., president of the 
American Institute of Homeopathy, remembered the members of the 
institute with a pleasant New Year's greeting in which he called their 
attention to the coming meeting at Jamestown, Va. 

The demands upon the Hahnemann Hospital of Chicago have become 
so great that patients are almost constantly being turned away for lack 
of accommodations. This is true both in the private and the ward de- 
partments. With the fine new buildings for nurses so nearly completed 
it is to be hoped that an enlargement of the hospital is not far in the fu- 
ture. 

The December issue of the Homeopathic Eye^ Ear, and Throat Jour- 
nal is devoted to a symposium on the submucous resection of the nasal 
septum. The papers -are " Septum Resection " by W. A. Phillips, of 
Cleveland; " Technique of the Operation " by H. W. Hoyt, of Roches- 
ter, and " Clinical Results in One Hundred Cases " by Burton Hasel- 
tine, of Chicago. These papers were read at the Atlantic City meeting 
of the Homeopathic O. O. & L. Society, and are published with the dis- 
cussions there presented. 

Physicians who are interested in the study and legitimate practice of 
the physical (drugless) therapeutic methods, notably electro-therapy, 
photo-therapy, mechano-therapy, hydro-therapy, suggestion and dietet- 
ics, are invited to join the American Physiotherapeutic Association. 
Address the Secretary, Dr. Otto Juettner, No. 8 W. Ninth St., Cincin- 
nati, Ohio. The officers for the ensuing year are: 

President: — Dr. H. H. Roberts, Lexington, Ky. 

Secretary: — Dr. Otto Juettner, Cincinnati, Ohio. 

Treasurer:— Dr. Geo. H. Grant, Richmond, Ind. 

Executive Council: — Drs. W. F. Klein, Lebanon, Pa.; Jas. Hanks, 
Brashear, Mo.; J. W. linger, West Point, Miss.; Chas. S. Northern, 
Talladega, Ala.; R. W. Gibbes, Columbia, S. C; S. J. Crumbine, To- 
peka, Kans.; A. L,. Blesh, Guthrie, Okla. 



In urgent cases a high tracheotomy should be performed, not a low 
tracheotomy. The former can be done very rapidly ; the latter requires 
considerable dissection. — American J onrnal of Surgery. 



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THE CLINIQUE. 

VOL. XXVI II. MARCH, 1907. NO. 3 



tjfhdginal Articles. 



THE MATERIA MEDICA FROM THE STANDPOINT OF THE 
GENERAL PRACTITIONER.* 

O. K. RICHARDSON, M. D., MINNEAPOLIS, MINN. 

The schools are as far apart today as in Hahnemann's time. " Sim- 
ilia similibus curantur " is the test. The dominant school does not 
recognize it, never did, and until they begin, the schools maintain the 
same relative position. It is decidedly unfair to us, however, to assume 
that we have been, and are satisfied with the materia medica as prom- 
ulgated by Hahnemann, Hering and others, without taking part in, 
and advantage of all the progress in adjuvants that the medical world 
has made. 

"The field of homeopathic materia medica, compared with the whole 
field of medicine, is a small one." One reason that the homeopathic 
physician of today seems a heretic is because, in competition with other 
men of brains, but of different methods, he has been forced to educate 
and familiarize himself with all the so-called modern ideas and methods 
of diagnosis, sanitation, hygiene, dietetics, pathological findings, etc., 
and it is the duty of every homeopathic physician to make his materia 
medica assume a background position until he has, by methods recog- 
nized and in use by all scientifically observing men, determined the 
diagnosis and pathology of his case. 

Some will immediately say, " Let the patient die while you are being 
a laboratory man?" To that question I can say, that if proper atten- 
tion is paid to those things in connection with the case, which common 
sense ought to tell us, the very large percentage of cases would not die, 
but on the other hand, would get well without a materia medica. I re- 
fer, as you know, to the bowel cleansing, diet, sanitary surroundings, 
etc. 



'Read before the Minneapolis State Homeopathic Institute, 1906. 



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130 THE CLIN I QUE. 

I would like to consider for a moment the bugbear of the profession, 
namely the "totality of symptoms." I have heard that subject dis- 
cussed and have been positively afraid that I could never attain it, un- 
til it seems to me it would be well for someone to explain the meaning 
of the old time phrase. That phrase means to me, not only the sub- 
jective symptoms, which are not always to be relied upon, but also what 
the physician sees, what he finds out by blood analysis, urinalysis, and 
any other analysis that is in existence or will come in. The diagnosis 
is a part of the ' 'totality of symptoms," and therefore, any means of 
diagnosis have a bearing on the "totality of symptoms." 

My contention is that a physician cannot hope to get the "totality of 
symptoms" until he has exhausted everything science offers him. 
When he has made his diagnosis, then is the time for exhibition of his 
homeopathic remedy, and then is the time when it is demonstrated. 
The best results I ever attained were by the use of the indicated homeo- 
pathic remedy, after I found it was indicated. 

From the talk of members of homeopathic societies, I have come to 
the conclusion that the dominant school has good reason to poke fun at 
our school. The talk of our members, and the printed evidence of our 
therapeutic imbecility, the average materia medica, which makes no 
mention of pathology or anything else but symptoms so-called, the ones 
of imagination mixed indiscriminately with the ones of authenticity, 
are the belittling and asinine conditions which stamp us as unscientific 
and quackish. 

Better far that we leave out the materia medica altogether, and be 
scientific observers only, than to prate about our materia medica, which, 
in its present state, is weakened by the dross. The idea of informing 
a student of materia medica, upon symptons only, taking, for instance, 
lachesis, and giving everything from the top of the scalp to the pedal 
extremities, giving in minute detail every impression which the drug 
produced or excited the imagination to produce, or which may be co- 
incident from other causes, is to my mind, simply an admission that 
pathology is needless, diagnosis useless, and knowledge of adjuvant 
treatment waste of time. 

How much better for the success of the prospective physician if he 
finds out what pathological conditions call for lachesis, and when he 
recognizes that pathology, he can administer his lachesis with sound 
judgment. I think the present method of teaching the materia medica 
is all wrong. Instead of supplementing a student's knowledge of path- 
ology by a clinical therapeutic application, he is bored to death by a 
system of observations, more or less sane as regards the treatment of 
disease. 



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THE CLINIQUE. 131 

A materia medica founded on pathology is really what the law of 
similars demands, and is what would place homeopathy in the van as a 
system of practice, and put the homeopathic physicians in a class by 
themselves, beyond a doubt. The successful homeopathic physician of 
today belongs to that class. Allow me a personal reference. The 
members of the homeopathic staff at the Minneapolis city hospital 
could not compete for one moment with the old school physicians, if at- 
tention were not closely paid to pathology, diagnosis, etc. In hospital 
work, especially in a charity hospital, there is time for a scientific 
diagnosis, and the man who ignores any means at command to arrive 
at a correct solution of the physical difficulty, will fall far behind in the 
race. The time was, I understand, when the less a homeopathic physi- 
cian knew about things outside the materia medica, the better homeo- 
path he was. Now, I believe the reverse is true; the greater general 
knowledge of medicine he has, the better qualified he is to select the 
remedy for the condition. Why should we not teach our students me- 
chanical materia medica? I mean the giving of cathartics, stimulants, 
and narcotics. Why should they not know these things, not only to 
use them wisely, when needed, but also to know what the other fellows 
do to the cases before we get them? These things should be taught by 
a competent instructor, so that when a homeopathic physician has need 
of them, he can use them judiciously. An homeopathic physician, fol- 
lowing old school dosage,, without the adequate knowledge, either 
didactic or clinical, is a dangerous man. 

"If a patient complain of one or more trivial symptoms, that have 
just appeared, the physician should not regard this as a fully developed 
disease which requires serious medical aid. A slight alteration in the 
diet and regimen will usually suffice to dispel such an indisposition." 
(150) Organon. From this we see that Hahnemann himself recog- 
nized the value and sometime sufficiency of adjuvant treatment. So 
when you do not find the indications for medical treatment, you are not 
losing caste as a homeopathic physician, by not giving medicine. 
Many times cases are entirely cleared of symptoms of abnormal condi- 
tions by unloading the system, bowels, kidneys and sweat glands by a 
process which is not homeopathic, allopathic or anything exclusively, 
but that commodity which all should have, common sense. We should 
be adepts in the use of it. 

In conclusion, it might be well to touch upon my subject somewhat. 
My words must savor of the personal to a certain extent. No man is 
his "brother's keeper," especially in a therapeutic sense; and the only 
way for me to reach a conclusion is from my own work. 



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132 THE CLINIQUB. 

I find the remedies in our materia medica absolutely sufficient for all 
the medication I need. Our worthy ex-president, Cole of Fergus, in 
his presidential address last year, divided the giving of drugs into palli- 
ative, antidotal, curative, and he might well have added, eliminative. 
I refer to the curative medication, in the statement just made, i. e., 
that the homeopathic materia medica is absolutely sufficient for all the 
medication I need. 

The popular idea is, that because of the lessened dose of the allopath, 
the schools are nearing each other. This, my friends, is nothing to go 
by. The allopath is acquiring the sense now, which has been his 
always, but which he did not recognize. 

What we must strive to do, is to let our position on therapeutics be 
known; that the dose has no bearing on our mode of practice. It is 
the law, and until the allopath approaches the law, he is still far away. 
Small doses and giving medicine in water does not constitute the law 
of similars. 

I cannot stop without a parting shot at the shotgun therapy of our 
school; I mean the combination tablet. They are handy, probably 
safe, and easy to prescribe (the pharmacy tells you how), but the com- 
bination tablet is the worst enemy of our school of practice, and the 
physician using it. Why not hold to the old medication, and the right 
law, and perfect ourselves in the adjuvant treatment, as it promulgated, 
and proven scientific. 



POTENTIZED VERSUS CRUDE DRUG.* 

W. H. LEONARD, M. D., MINNEAPOLIS, MINN. 

You may not expect anything new or original in this paper. The 
subject has been "harped upon many times and the stuff written has fre- 
quently grated upon the nerves of good readers, who were anxious to 
learn something in advance of what they now possess. There is many 
times a necessity for the memory to be refreshed on what should be fa- 
miliar subjects, lest we forget, and lose a golden opportunity to cure a 
simple case in a simple manner with the right selected remedy. But 
not only that, lest we forget the law of dynamics, and use the 
crude drug instead of keeping to our early lessons of the law of 
cure, that potency is better than crudity. We are dealing with life. 
It is itself a potency. The drug from which we get the potency was a 

* Read before the Minnesota State Homeopathic Institute, 1906. 



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THE CLINIQUE. 133 

dynamic before it became the drug. Nature is friendly to us if we use 
her methods in an intelligent manner. We have the right to know 
these methods, and to use them to advantage in diseased conditions. 

What can you do in traumatism with crude drugs ? Absolutely noth- 
ing. A case to illustrate — Mrs. C. age fifty-five years, excellent health, 
caring for her household and family with great efficiency, became pros- 
trated suddenly with frequent recurring headaches, faintings, and great 
weakness, a total wreck. Two or three physicians were non-plussed, 
the patient and friends discouraged. A homeopath came across the 
case and inquired into the cause. She had received a blow upon the 
head three years before, causing unconsciousness at the time. Here 
was a case of traumatism. A dose of arnica, 200, made a wonderful 
change. One dose of the same remedy a month later has made a well 
woman. Crude drugging did her harm. She would have fallen into 
some form of disease caused by the drugs in their effort to accomplish a 
result contrary to that indicated by nature, making nature her enemy 
instead of a friend. Nature is always our friend if we use her means in 
a legitimate way. We should keep to the front our observations on the 
traumatic cause of many conditions we find in our patients. 

A gleaning from the proprietary medical literature of the day (these 
gleanings are the armamentarium of many physicians at the present 
time) this fact is stated — that a tumbler of lime water taken for a fort- 
night daily will cure warts. Now don't put this down in your note 
books. By referring to the proving of calcarea carb. you find the char- 
acter of the warts the remedy will cure in potency without harm.. It is 
not possible that you have to resort to lime water when milk disagrees 
with children. The right potency of the indicated drug does the work 
harmlessly, which might not be the result of drenching the stomach 
with lime water* 

There has been considerable said of late about " amalgamation," and 
dropping the name homeopathy. Why so? The school started under 
this name and has reached its present status without disgrace. Is the 
name a misnomer? We have sailed under these colors so far, and it 
happens that the mordant of truth in their composition is such that ex- 
posure to .the light does not fade them. If they stand the effect of light 
they will withstand all other exposure, for the light of intelligence is 
the test of our right to exist. Is the desire for such change in defer- 
ence to our old friends, the enemy, whp have been our enemies always 
from the first? We do not need to change in front of the enemy, nor 
is there any reason for doing so in front of our friends. 

" A man who is right, is ready to fight," when necessity demands. 



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134 THE CLINIQUE. 

There is a disposition to be broad in thought. It is better to be free. 
There can be no freedom except under the banner of truth. If we 
throw away our name we throw away our color. Every principle lias 
its name and hence its color. Even our five senses have each its light 
or color and character, indicating that light exists in our material 
bodies, and it is the same light that was announced from antiquity: 
" Let there be light and there was light." Let us not obscure the 
light in any of our modes of thinking, but let the light shine into the 
dark places that it may dispel the shadows. The holder of the truth is 
the servant of truth and must stand by it. He has the right and it is 
his duty to strengthen the weak brethren. The admonition to the 
church in Sardis as given in the Revelation is quite appropriate in our 
school, — " Be watchful and strengthen the things that remain, that are 
ready to die." We cannot afford to scold those who may not use the 
drug above the first dilution, or not above the decimals. He is con- 
vinced of the truth. Let him be strengthened and encouraged to see 
more of the truth, that " the things that remain " may not die. Let 
us believe and practice the law of similia, which includes that of 
potency. 



ACUTE CATARRHAL BRONCHITIS.* 

GEO. G. BALCOM, M. D., LAKE WILSON, MINN. 

In preparing a paper on this subject, I cannot believe that my whole 
duty toward you would be properly performed, if I should make a hap- 
hazard compilation of clinical data gathered from the various authori- 
ties at my disposal and append a long bibliography for your further 
perusal. My idea of a clinical paper, which shall be of value to you, is 
one in which I set forth some of my personal experiences. For I take 
it that it is reliable clinical facts gathered in this particular locality, 
which will be helpful to you, and call out discussion. I say " in this 
particular locality " not because there is such a wide variation in etio- 
logy and symptomatology, but in treatment. 

Our authorities vary as they practice in the different parts of this 
country, and since climatic conditions are so great a factor in the treat- 
ment of this disease it, of necessity, follows that my discussion of treat- 
ment would be confined to such as is suitable to this locality. 

Acute bronchitis is an acute catarrhal inflammation of the tracheal 



*Read before the Minnesota State Homeopathic Institute, 1906. 



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THE CLINIQUE. 135 

and bronchial mucous membrane, almost always bilateral and affecting 
mainly the first and second divisions of the bronchi. The most fre- 
quent cause is the exposure to cold or sudden chilling of the body. 
The extension of an inflammation from the nasal, pharyngeal or laryn- 
geal mucous membranes, during an attack of coryza, may set up an 
acute bronchitis. It is almost always a symptom of influenza and 
measles. We need not note the cause that certain occupations offer 
for the production of this disease, but there is one thing in our houses 
here that deserves special attention. I refer to the ordinary hard coal 
heater, poor mica, poorly fitted doors and carelessness on the part of the 
one regulating the stoves, may allow enough coal gas to escape to keep 
half the family sick with bronchitis. 

Symptoms. — The attack is usually ushered in with all the usual 
symptoms of a cold, such as coryza, sore throat, hoarseness and sneez- 
ing, pain in the back, soreness and constriction of the chest. The con- 
striction amounting to dypnea in some cases. Cough is a constant and 
conspicuous symptom; at first dry and painful, with a sensation of 
rawness in the pharynx extending the whole length of the trachea. 
Severe paroxysms are quite frequently observed during the first twenty- 
four or forty-eight hours. The expectoration at first is very scanty, and 
of a mucoid character, but later it becomes more abundant and assumes 
a muco-purulent condition, being composed of epithelial cells, pus cells, 
oil globules, bacteria, leucocytes and sometimes small quantities of 
blood. If the attack be a severe one, the temperature during the first 
twenty-four hours may touch 102 %° or even higher. In ordinary 
cases, however, the temperature would range between 100° to 101°. I 
have never found the temperature range of much service, only as it 
pointed to the complications. The rate of the pulse is generally away 
out of proportion to the temperature, so that a pulse ninety-five or 
one hundred is not very unusual during the early part of an attack. 
This is seldom altered, unless the temperature be high or the small 
bronchi involved. 

Physical signs. — Palpation, percussion and inspection reveal very 
little. Auscultation in the early hours of the attack, shows harsh- 
ness of the breath sounds, while dry, sonorous and sibilant rales may 
come and go in either lung like the changing colors in the kaleidoscope. 
When resolution sets in, bubbling rales are easily heard over the greater 
part of the anterior aspect of the chest. 

The diagnosis of simple catarrhal bronchitis is generally a very,easy 
matter. The fact of an exposure or influenza being epidemic, or the 
patient having had measles, the dry rales during the first day or two, 



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136 THE C UNIQUE. 

the low temperature range and the various subjective symptoms gleaned 
from the patient's statement of his feelings, the bubbling rales after 
the disease has persisted for sometime, all point to an acute catarrhal 
condition of the bronchi. 

In the diagnosis of this disease, I wish to emphasize the great use- 
fulness of the microscope, for since beginning the preparation of this 
paper, I saw a lady, who was supposed to have acute catarrhal bronchi- 
tis, but on the next day after my visit, I examined the sputum for tu- 
bercle bacilli and found them in abundance. 

Treatment. — Under this head I wish to sound a note of warning 
against the too oft repeated stereotyped paragraphs found in the text 
books, which give the general impression to students and practitioners, 
that the treatment is simple and thus of small consideration. My ex- 
perience is quite different, for among the various diseases, which present 
themselves there are none which makes such heavy demands upon our 
skill, tact and general ability, to take close and accurate inventory of 
our patient's exact physical condition. For it is this close sizing up of 
our patient, which adds for weal or woe, and becomes a mighty factor 
in our special and general medicinal and therapeutical efforts. To 
illustrate: — What one among us has not seen the simple bronchitis in 
an anemic or scrofulous patient swiftly followed by tuberculosis of the 
lung? Again, the patient has successfully withstood the ravages of a 
severe attack of " Grippe, " only to be caught in the greedy maw of 
tubercular disease. For convenience I will discuss the subject of treat- 
ment under the following heads: — ( 1 ) General Therapeutical measures. 
(2) General Medicinal. (3) Special Medicinal. Of the many gen- 
eral therapeutical measures I consider proper clothing as first upon the 
list. Woolen, if the patient can wear it, from head to foot. If con- 
fined to the house a temperature of about 70° is none too warm. I find 
that old people enjoy a higher temperature and I think that it is well to 
order that they keep their rooms warm, even to 75°. A' small amount 
of moisture in the air is beneficial. This can be secured by placing a 
small basin or kettle on the heating stove. I absolutely forbid bathing 
in old people, but in young vigorous subjects, I recommend a hot bath, 
followed by a brisk rub, with orders to remain indoors for at least two 
or three hours. 

Under the head of general medicinal treatment I would recommend 
cod liver oil, quinine, strychnia sulphate, and iron, either in the form 
of Blaud's pills, or some of the various solutions or elixirs. These 
remedies are usually to be chosen to combat some other condition out- 
side of the bronchitis, or they may be found useful during the conva- 
lescence. 



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THE CLINIQUE. 137 

Special medicinal treatment. — Remedies under this head must be 
chosen to suit the symptoms. In the beginning, if the fever be high, 
aconite in small, oft repeated doses generally relieves. Veratrum vir. 
and gelsemium are also very useful. Counter irritation should not be 
forgotten. A turpentine stupe is often very agreeable, while if there 
be pleuritic pains, a mustard plaster is of marked service. Inhalation 
of steam with compound tincture of benzoin in the water helps to re- 
lieve the tight cough. This symptom is the one uppermost in the 
mind of the patient, and very often the means of causing the disinte- 
gration of several gray cells in the brain of the attending physician, 
and for its relief I rely upon bryonia, belladonna, phosphorus and her- 
oin hydrochloride given generally in a syrup. If the cough is dry, 
with pleuritic pains and soreness across the chest I give bryonia the 
preference. If the cough is dry and occurs in paroxysms belladonna is 
helpful. Heroin hydrochloride has relieved those cases where there 
seemed to be no remission of the cough; just a dry, continuous, tick- 
ling cough, then 1-12 grain or 1-6 grain gives almost instant relief. I 
have found it more useful than any other opium derivative. When there 
is an abundance of secretion, another line of remedies are to be thought 
of. The ones which are favorites with me, are iodide of antimony 
1-100 grain tablets, balsam copaiba in capsules, tincture of ipecac in 
syrup, and if the cough interferes with the patient's sleep, I prescribe 
codeine phosphate % to % grain. 

It may be of interest to you to know how I used the balsam copaiba. 
I give it in the No. 2 gelatine capsules and direct that three or four be 
taken during the day. I have had such success with it in chronic cases 
of old people, that I very frequently use it in the acute cases, where 
there is an abundance of mucus. I am free to admit that I often have 
recourse to other special cough remedies and among the vast array of 
simple and compound cough syrups, I cannot speak too highly of the 
simple syrup of the lactucarium prepared in France by Aubergier. 
It is rather expensive, but I cannot get along without it. Of the 
compounds the white pine expectorant, either plain or with heroin, are 
the ones I have had the most experience with. 

DISCUSSION. 

Prof. Wm. E. Leonard: Dr. Balcom is to be congratulated upon 
presenting a timely and practical topic in an original and practical 
manner. Every general practitioner realizes the importance of the 
affection he has chosen for his paper, and the extreme difficulty which 
its speedy cure often involves. His paper is worthy of note for its evi- 



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138 THE CLINIQUE. 

dence of observation outside of the text-books; for instance, his sage 
statement concerning the escape of coal-gas as a recurring cause for 
acute bronchitis, and his sensible " general therapeutic measures.' ' 

I would venture to add that this disease or group of symptoms, not 
only accompany, as he has said, influenza and the exanthems, especi- 
ally measles, but also whooping cough, and that the uucured remnant 
of that cough, oftentimes a real acute bronchitis, with slight tempera- 
ture, is almost as menacing as after measles. 

However, I do in the main agree with Dr. Hall as to the treatment 
recommended. Dr. Balcom was a student of mine at the University, 
and I am ashamed and chagrined that he so far forgotten the therapeu- 
tics I there attempted to teach him. He has certainly u fallen from 
grace," and I am very sorry for it, nor do I think that such a paper is 
appropriate in a homeopathic society whose purposes are supposed to 
be the teaching of our special therapeutics. That he found it neces- 
sary to resort to the various drug adjuvants mentioned proves to me at 
least that he has lost confidence in the homeopathic remedy. He should 
have learned by this time that the use of opiates in any form almost in- 
variably suppresses a cough and thereby destroys a valuable symptom 
and also makes it more difficult for the patient to do the necessary ex- 
pectoration. In many years practice I have not found it obligatory to 
use the adjuvants mentioned in order to cure my patients; if I had I 
should openly practice according to the dominant empirical school. I 
insist that the doctor's list of homeopathic remedies for bronchitis is 
altogether too meager and insufficient, and that his paper is therefore > 
as to its therapeutics, out of place in a homeopathic society. 

Dr. O. H. Hall: u I want to ask if this is a homeopathic society and, 
if not, what it is? I want to say that I am ashamed of the paper just 
presented. I am ashamed of the doctor who presented it ; and I want 
to say that if he has not a homeopathic materia medica that I will give 
him one. If this is a homeopathic convention I am here to stay and to 
take part, but if it is not I want to get out. And if this is a homeo- 
pathic institute I want to hear homeopathy. " 

Dr. Balcom: "I consider bryonia and phosphorus and belladonna 
as homeopathic to cases of bronchitis. My way of treating has cured 
my cases and made a living for me, and that's about what we are all 
after. I know many homeopathic physicians, members of this institute, 
who use the compound syrups, etc., but who do not admit that they 
use these old school prescriptions." 



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THE CLINIQUE. 139 

CONGENITAL ABNORMALITIES.* 

J. THEO. SCHLESSELMAN, M. D., GOOD THUNDER, MINN. 

The natural requirements for the birth of a mentally and physically 
sound child, are parents who are mentally and physically normal and a 
normal course of gestation. The healthy origin of the embryo and its 
unimpaired development, determines the final production of a healthy 
human life. Whenever there is a faulty origin of the embryo and there 
are any external causes that hamper its free development, a great many 
mental and physical defects may arise. 

A number of obstetrical abnormalities have come under my care that 
show them to be more common than is generally supposed. On Feb. 
21, 1904, Mrs. B. aet. 26, gave birth to a boy with both arms ampu- 
tated at the middle of the humerus, the right leg at the knee and the 
left foot was minus the second toe. All were clean cut amputations 
with perfect stumps. The child weighed eight pounds and was other- 
wise normally developed. • It died when three months old after expo- 
sure. 

Other births were: On Dec. 2, 1904, a boy with spina bifida, ankylo- 
sis of hips and talipes. 

On Feb. 24, 1904, a girl with hare-lip. 

On Feb. 13, 1903, an undeveloped child of 3*4 pounds with a cleft 
palate. 

On Feb. 25, 1904, a boy with ankylosis of hip. 

In the spring of 1903 two cases of underdevelopment, the children 
weighing less than 3 pounds at birth. Now at three years the one is a 
helpless being of 15 pounds and the other about a year behind in de- 
velopment. Previous to these were a case of cretinism and a case of 
congenital atrophy of one eye. Some other obstetrical misdevelopments 
were a placental mole and a spurious placenta. 

Causes for such abnormalities may be classed as : I. Hereditary or 
internal. II. Local or external. 

Hereditary or Internal causes are impressions from heredity or 
atavism producing a defective origin of embryonic life. The influence 
of heredity is recognized in cases of hare-lip, supernumerary fingers and 
toes and the like occurring in certain families for successive genera- 
tions. Tuberculosis, syphilis and other constitutional diseases may 
cause a defective origin of the embryo through mal-nutrition. 

Local or External causes which are more frequent and important are 



♦Rdai before the Minnesota State Homeopathic Institute, 1906. 



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i 4 o THE CLINIQUE. 

those which affect the embryo during its development, as traumatism, 
pressure, fetal infections and inflammations. Traumatism from exter- 
nal violence and attempts to produce abortions may cause separation of 
parts of the embryo from the maternal tissues. This will account for 
consequent malformation or retarded development of those parts which 
ought to derive their nourishment through the separated areas. 

The uterine contents may become infected through the liquor amnii 
by the use of douche tubes and other instruments. Acute infectious 
diseases like scarlatina, smallpox, erysipelas, gonorrhea and septice- 
mia may influence the uterus and its contents, as may the chronic in- 
fectious diseases, syphilis and tuberculosis. In the early months of 
pregnancy, when the amount of the amniotic fluid is small, inflamma- 
tions will set up adhesions between the embyro and its membranes, 
which are facilitated by the fact that the outer surface of the embryo 
and the inner surface of the amnion are covered by the same membrane, 
the ectoblast. When the adhesions develop early they may encircle 
extremities and amputate them, as in case mentioned. Being soft and 
gelatinous they are readily absorbed. When the adhesions form later 
they will only arrest the development of the parts. Pressure and ad- 
hesions to the spinal canal will produce spina bifida by preventing its 
closure, when to the cranial structure, anencephalus is the result. Cleft 
palate and hare-lip result from non-closure of the facial clefts from the 
same causes. Even when the inflammations do not form adhesions 
they may stop the secretion of the liquor amnii, the lack of which will 
interfere with the free movements of the child and by pressure and fix- 
ation create ankylosis of joints and talipes or hold the child in an un- 
favorable position for a normal birth. 

When from any cause the embryo dies it may be absorbed and its 
membranes continue to develop resulting in placental moles. The con- 
dition of supernumerary placenta is of clinical importance as it is likely 
to be overlooked, causing serious hemorrhage, an experience I had in 
the case mentioned. Congenital mental defects are largely hereditary, 
but are no doubt affected by local influences. Hereditary causes are 
unavoidable and have therefore no remedy excepting to better the gen- 
eral moral and physical standard. Some local causes are accidental 
and unavoidable as traumatism and unrecognized uterine and constitu- 
tional disease. Endometritis, metritis, flexions and growths ought to 
be corrected when healthy offsprings are expected. I believe a large 
number of abnormalities arise from the common practice of producing 
abortions whether instrumentally or by the use of emmenagogues, 
which when not accomplishing their purpose seriously retard the child's 



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THE CLINIQUE. 141 

development at the most important formative period. The detrimental 
consequences from stimulating an already hyperemic uterus by the use 
of emmenagogues are apparent. Their use ought to be discouraged or, 
better, their sale prohibited. The laity usually finds its explanation 
for abnormalities in maternal impressions, some mental shock to the 
mother during pregnancy. Scientific investigations do not uphold this 
theory but some influence good or bad of the mother's mind on the 
delicate nervous system that is being formed must be admitted. If in 
the first months of pregnancy a mother's every thought rebels against 
the existence of the human life that is developing within her and uses 
all possible means to destroy it, who can doubt that there is a criminal 
tendency implanted into that child that may some day show itself? 

It is indeed a sad duty for parents to be compelled to bring up such 
an unfortunate being, whether its abnormality be physical or intellectu- 
al, but they will suffer less remorse if they feel it occurred through no 
act or neglect of theirs. Every child's birth-right demands that its 
parents do all in their power to give it a mind and body that will come 
up to the highest possible standard of soundness. 

DISCUSSION. 

Dr. Rome: u I have had no experience thus far in delivering a 
monster. I have no doubt, however, but that, where a mother has 
decided to destroy the life of her child, such would have its effect. I 
believe there is a law that governs irrespective of criminal acts of pros- 
pective mothers. The child is an individual being and, though the 
mother may have thoughts of destroying her child, those thoughts will 
not materially affect the fetus. " 

Dr. W. E. Leonard hesitates to believe in the baneful effects of 
maternal impressions upon the offspring. 

Dr. Ashley: "I believe strongly in prenatal influence — from the 
intellectual standpoint." 

Dr. Connolly: " I believe that the influence of the mother is great 
upon the^unborn." 

Dr. Booth: "I fear that we may think too much of pre-natal and 
overlook the post-natal influences (i. e., environment) of first three 
years particularly. I believe much in post-natal influences." 

Dr. Ogden: "I think there is a great difference between pre-natal 
influence and heredity. I fear we may be mixing our meaning." 

The doctor's experience seems to me unusual, as in over 1300 cases 
I can recall at this moment only two cases of hare lip, two spine bifida, 
one meningocele, three hydrocephalus, one anencephalus, two hypos- 



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14# THE C UNIQUE. 

padias, and three angiomas. This may not be all, yet even double the 
number, and the proportion of deformity is still small. Most of these 
deformities are due to arrested development, mental shock, perhaps in- 
terference to prevent continuance of pregnancy are frequent causes, but 
often we cannot find a cause. I think we are too apt to fall in line with 
the suggestions of our patients as to the cause of certain conditions and 
thus foster ideas which we know are unfounded. I believe a good deal 
of emphasis should be given to the doctor's statement that instrumental 
or medicinal interference to interrupt pregnancy is often a cause of de- 
formity. In considering the subject of pre-natal influence we must be 
careful to avoid confusion with heredity. The two are not synonymous. 



HOMEOPATHY, UNDER THE SUB-HEAPS OF FAITH, HOPE 

AND CHARITY.* 

S. H. AURAND, M. D., CHICAGO, ILL. 
FAITH. 

Faith may be defined as the assent of the understanding to any truth. 
There seems to be such a thing as a dead faith and a living faith. A 
dead faith is to assent to, or believe a truth, without living or practic- 
ing it. A living faith is to assent to, believe, live and practice the 
truth which you believe. We have three kinds of doctors, the allo- 
paths, who have no faith in homeopathy, the homeopaths who have a 
dead faith, and the homeopaths who have a living faith. The future 
and the efficiency of homeopathy must depend upon the latter class. 

We do not wonder that our old school brethren have no faith in the 
homeopathic system of therapeutics. To possess faith in any natural 
law — or indeed in any thing — one must have some knowledge of its 
operative truthfulness. Theoretical knowledge sometimes will do to 
produce theoretical faith, but it requires experimental, active, knowl- 
edge to clinch the facts and to produce enthusiastic, working faith. 
Our young homeopathic students and doctors have plenty of enthusiasm 
and theoretical faith, but in their first years of practice they are some- 
what deficient in the real, experimental, or working faith. This is the 
stage in the doctor's career when he is most liable to waver. He has 
not manipulated the homeopathic law long enough to become thorough- 
ly familiar with, and to have substantial confidence in it. It is in this 
embryonic stage that our physicians are most liable to adopt allopathic 
methods to the sacrifice of better homeopathic therapeutics. 

*Read before the Minnesota State Homeopathic Institute, 1906. 



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THE CLINIQUE. 143 

There are two very plausible reasons for this: first, because it is more 
popular, and second, because it is easier to apply. We seldom hear of 
a doctor who has practiced homeopathy for a few years renouncing its 
principles for anything that any other system of medicine can offer. 
The rule is that those who study and practice homeopathy grow stronger 
in their faith as the years go by. This at least accords with my experi- 
ence and observation. I see homeopathy today, after 22 years' practice, 
with greater faith in the accuracy of its operative law than ever before. 

It requires a reasoning faith to enthuse a student sufficiently to suc- 
cessfully prosecute his studies, but it requires a practical, or working 
faith, to sufficiently establish a doctor in the principles of his system to 
make him a dependable pillar. A waning faith in the principles of any 
business or profession will soon bring its stock value below par. The 
Good Book says: u According to your faith be it unto you." If a man 
really believes a thing it requires but little to stimulate him to action, 
in accordance with his belief. What homeopathy needs today, is hon- 
est, sincere men of conviction — pharmacists as well as doctors. Men 
who are willing to thoroughly investigate the homeopathic principle, 
test it as did Hahnemann, by research work and otherwise, and then 
when thoroughly convinced, decide for or against it and act accordingly . 
Half heartedness will not do. 

We must, if we expect to preserve and promote our dearest principle, 
select men of strong convictions to lead us in our colleges, hospitals 
and especially in our public institutions. I mean by this, men of the 
following order, first, men, second, doctors, and third, homeopathic 
doctors. Men who would not allow " ism " or "pathy " to stand be- 
tween them and sacred duty at the bed-side of a confiding patient. 
Men whose faith and convictions are strong enough to not tolerate any- 
thing else when homeopathy is applicable. Men who' are big enough 
and strong enough, in the light of our present therapeutic knowledge, 
to accept that which is best demonstrated at the bedside as the most 
scientific prescription. Men who can comprehend the heighth and 
depth and breadth of the homeopathic law and who can realize that it 
has coarser and finer operations according to the accuracy of its appli- 
cation. Men who can realize that if the law of similia is the only true, 
natural therapeutic law, it must follow that all emergency measures, 
palliatives and auxiliaries, which are helpful or curative in a degree, 
must be subsidiary to this main law. These are the homeopath's legiti- 
mate emergency helps but they are not to be commended as the finest 
and best curative measures to which the homeopath has access. 

The much discussed question of potency has acted and reacted upon 



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144 THE CLINIQUE. 

the members of our profession. It has increased, diminished, pre- 
vented and destroyed faith in our system of therapeutics. All this has 
come about through the lack of conservatism and discretion on the part 
of those whom we must term extremists. The question of potency 
must and should be settled, in- each instance, by the convictions of the 
doctor and the condition of the patient. When all conditions are con- 
sidered a wide and liberal range of dose must be acknowledged by all of 
us. There are two wide extremes which may be convenient, and even 
necessary, for most of us to touch, but none of us should hobby 
either of them. The homeopath who attempts to constantly imitate 
the allopathic empirical method of prescribing, and the one who is 
eternally soaring into the realms of unusually high potencies are equally 
guilty of going to the extremes, and of bringing criticism and odium 
upon our system of therapeutics. Both of these extremes indicate dis- 
satisfaction, discontent, loss of faith and lack of ability. There is a 
common ground which must be recognized by all systems of medicine 
and upon which we all, alike, have the privilege and right to tread. 
But it must be a man who lacks ability, is lazy or a hobbyist, who de- 
sires to loiter upon such a plane all the time. It is true there are oc- 
casional demands for unusual extremes, in all of our practices, but to 
continue along these lines and to constantly preach such doctrine will 
bring ridicule, not only upon the man himself, but upon the profes- 
sion to which he belongs. Such doctrine and influence tends toward a 
one-sided system of medicine, which eventually must develop into a 
monstrosity— like Dowieism and the various other cults which are 
gradually but surely meeting their inexorable fate. Reach out boys, 
as far as your brains and arms will allow, but keep your feet planted in 
the middle of the homeopathic road. 

HOPE. 

Hope means a desire for, together with a confidence in, and an ex- 
pectation to attain to, the amplification of a certain truth. 

Our hope must rest in our ability to make homeopathy equal to the 
demands of the times. This means that efficiency, and not commercial- 
ism or selfishness, must be the guiding spirit of our profession. We 
must educate our doctors in accordance with the demands of the twen- 
tieth century. The dignity, leadership, substantial teaching and prac- 
ticing ability of homeopathy must, not only be maintained at its pres- 
ent standard, but it must be raised to that high plane which this illum- 
inating and progressive age demands. We are in the minority, there- 
fore it is not sufficient that our students, and doctors, are simply, able 



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THE CUNIQVE. 145 

to cope with the best, but they must be able to surpass the best, both in 
practice and civil service examination. We are derelict in our duty if, 
with our splendid opportunities, we allow the brilliant therapeutic gem 
of homeopathy to become tarnished with ridicule, or to be torn from 
our grasp by chicanery. Self satisfaction and triumphant glory, 
flaunted to the breeze upon our banners, will not satisfy the demands of 
this inquisitive and practical age. We must buckle down to our task 
with the view of accomplishing our share of the splendid achievements 
which are adding luster to the medical world. 

Secondly, the hope of our efficiency and future usefulness depends to 
a large degree upon the conservation of our forces and the union of our 
efforts. We must not allow the high potency theory on the one hand 
and the allopathic trend on the other to disintegrate our forces or swerve 
us in the least from the path of duty. Already there is a strong ten- 
dency toward a division in our school of practice. Nothing can be 
gained by dividing ourselves into two opposing factions, but much harm 
may come to us through such proceedings. It seems to me that the 
proper course is to support no factions, for by keeping in the middle of 
the road we can best conserve our strength and direct it with greater 
power to the support of homeopathy. As I have already said in another 
paper : — If we are sincere in our desires to build homeopathy then let 
us patiently, presistently and unitedly labor on, not with a spirit of rule 
or ruin, but with a laudable ambition to convince and educate. Each 
individual doctor has the right to his own opinion as to what constitutes 
a real good, pure, up-to-date homeopathic physician. But none of us 
have the right to make this opinion the basis for the government and 
control of the homeopathic system of medicine. We must remember 
that the homeopathic law and the homeopathic system of medicine are 
two united propositions. The homeopathic law is the guiding principle 
of the homeopathic system of medicine, but the homeopathic law is not 
and never can be the homeopathic system of medicine. Much more 
must be involved in an up-to-date system of medicine than simply a 
guiding therapeutic principle. The law of similia is our watch- word, 
our guiding star, our unchangeable law of cure, but it must be sur- 
rounded with many other things to complete a system of medicine. A 
system may have a principle or governing law, but it can not be com- 
posed of one thing. It is an assemblage of objects, facts or principles 
which bear relationship to each other and are scientifically arranged to 
complete a whole. Thus it becomes plain that in rounding out and 
completing our system of medicine, if we would live, preserve and pro- 
mote our dearest principle, we must adapt it to the demands of the 
times. 



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146 THE CLINIQUE. 

Around this nucleus of similia may, and should, be entwined many 
helpful accessories. Every palliative measure, every auxiliary, every 
suggestion, every mechanism, every new discovery, every move in the 
direction of medical progress, no matter by whom put forth, should be 
hailed with joy and investigated with earnestness. All nature's helpful 
and health-giving measures must be subsidiary to her great underlying, 
life-giving principle which everywhere is exemplified through the oper- 
ation of the law of similars. With our lack of ability to absolute 
correctness in the application of any therapeutic law we must 
recognize all therapeutic measures whose science can be practically 
demonstrated at the bed-side. We cannot deny the homeopathicity of 
any helpful therapeutic measure until we can demonstrate scientifically, 
beyond the question of a doubt, that it is not homeopathic. We can- 
not hold individual doctors responsible for their apparent unhomeopathic 
prescriptions until we can demonstrate, scientifically, that our opinion 
of the homeopathic law is all there is to it. It is the duty of our insti- 
tutions to thoroughly and practically educate our physicians, but it is 
the duty and the prerogative of tjie physician at the bedside to prescribe 
what in his judgment the conditions and surroundings of his patients 
require. 

Thirdly — Our hope for recognition as a leading medical system should 
stimulate us to condemn quackery in all its forms, and to strengthen 
our organizations commensurate with our great therapeutic possibilities. 
Quackery in medicine should be discouraged, and under the guise of 
cult, pathy or scientist, should by law be prohibited from receiving re- 
muneration for its services. The efficiency of the profession of medi- 
cine must become equal to its duties and its responsibilities. 

To accomplish this does not require a monopoly on the healing art, 
but simply a righteous regulation whereby quackery and inefficiency, in 
all their forms, may be driven to the wall. Justice and fairness require 
that all who profess to practice the healing art should be governed by 
the same general rules. If the legitimate medical student is required 
by law to undergo a four years' course of training and then a rigid ex- 
amination — all who wish to compete with him in the art of healing 
should be required to do the same thing. In addition to this, each sys- 
tem should be required to make special preparation and undergo special 
examination in its legally recognized therapeutics. I believe that the 
law should go farther than this, and require that each active practician 
retain a membership, in good standing, in the principal organizations 
of his special system. 

If the medical profession accomplishes the design of its existence it 



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THE CLINIQUE. 147 

must comprehend the full scope of its responsibility. Not only this but 
it must unitedly set itself to its task to both destroy and build until it 
reaches that degree of efficiency which will be recognized by all as the 
best source for physical needs. 

CHARITY. 

" Charity suffereth long and is kind." By charity we mean that 
disposition of the heart which inclines men to think favorably of their 
fellow-men, and to do them good — (Webster). Along these lines we 
are indebted to our medical system if we make it all that it may be. 
First, I think homeopathy should be charitably inclined toward itself; 
Second, its members should be charitable to each other; and, Third, 
homeopathy should be charitable to all other systems of medicine. • 

If homeopathy is charitably inclined toward its own system of medi- 
cine it will not strive to deprive it of any thing which is needed — and 
which may be added, in the light of our present science — to make it the 
best, and leading, medical system of the world. It will not strive to 
narrow its scope nor its responsibilities. To limit the system of 
homeopathic medicine to our present knowledge of its operative thera- 
peutic law is not only very uncharitable but it is non-progressive, un- 
scientific and unwise. To limit the law of similia to one single phase 
of drug action, which might be represented by a straight tree without 
any branches, is in my opinion both uncharitable and unscientific. 
For as I said before, this great fundamental truth — law — must, if it is 
not unlike all other of nature's laws, have subsidiary laws — branches 
or truths. These, like the rays of the sun, may exercise their power 
at different angles — with different force — with different degrees of cur- 
ative power — according to the skill of application, etc. Who dare say 
that there is no curative power in electricity, as understood today? 
And who is willing to say that its therapeutic value may not be in- 
creased 50 or 100 fold when our skill of application increases — when 
we have followed its branches to its most powerful law — when we know 
more of its beneficent, homeopathic, law? Who is willing to say today 
that it does not belong within the scope of the law of similia similibus 
curantur? We must, and should by right, claim for the homeopathic 
system of medicine all that is ours by tradition, by inheritance, by 
right. 

It seems to me of the greatest importance if we would support and 
strengthen homeopathy, that we be united in spirit and in action. 
This demands the greatest breadth of charity toward each other. 

The question of dose or potency is admitted by all to be entirely sep- 



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148 THE CLINIQUE. 

arate from the question of the homeopathic law. He is admitted to be 
a homeopath, just as good, who prescribes in accordance with the law 
of similia, whether he gives the tincture or the 1M potency. Whose 
opinion is absolutely right ? Until we know, let me appeal to your 
greatness, your judgment and your strong interest in homeopathy, to 
be most charitable with your brother homeopath whose opinion, in this 
regard, may differ from yours. 

If we would occupy that high plain of medical ethics and make our 
system of medicine as large and great as the possibilities of its thera- 
peutic law, then we must look with righteous charity upon the good 
there is in all systems of the healing art. Selfish and extravagant 
claims, with assured satisfactions, may be factors which cause many of 
us to scan lightly or even look with disfavor upon much of the valuable 
work which is constantly being accomplished by the medical profession 
as a whole. A medical system that is commercial or exclusive or dog- 
matic or selfish or small cannot endure the rigid search lights of these 
illuminating times. Therefore we must be big and broad and liberal, 
and yet solidly homeopathic to the core. 

We cannot afford to belittle ourselves by ridiculing, or even speaking 
lightly of, a medical system which has delved deeply into the undiscov- 
ered mines and brought forth vastly more, along numerous important 
lines, than we have. We should kindly and gracefully admit and with 
a spirit of commendation and gratitude accept what they, through their 
faithful toil and devoted energy, have accomplished. Their fidelity and 
earnestness to a cause, in which their sacrificial devotedness demon- 
strates unbounded faith, must, on the basis of righteous liberty, be 
recognized by us. We must, if we are just, give them credit for the 
possibilities of the discovery and development of the homeopathic law. 
For Hahnemann as well as many others of our master builders received 
their fundamental medical training at the hands of the rational 
school of medicine. We are today indebted to them for much 
in modern pathology, research work along various lines, text books, etc. , 
which are very helpful to us and without which our educational institu- 
tions would not be so well equipped. These, ladies and gentlemen, to 
my mind are facts and if we expect to be great aS a medical system and 
of the most use to the world we must rise to that high plain of 
medical ethics where we can gratefully and gracefully admit them. 
Never can we allow any individual, or combination of individuals, to 
outdo us in politeness and common courtesy without at once taking an 
inferior rank. 

This period of the world's history, like all others, demands a certain 



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THE CLINIQUE. 149 

fitness which is commensurate with the times, and to which we must 
attain, or like all other failures go down under the action of 
the inexorable law of the survival of the fittest. All of the 
existing symptoms of mecjicine have had their part in the attain- 
ment of the present achievement of medical excellency. All 
must maintain a standard of usefulness which is measured by 
the demand of the times or be crowded out by those that do. 
The task of the medical system of today is too gigantic, their duty too 
sacred and their responsibility too great to waste any time in the en- 
gagement of a warfare for the ascendancy over each other. Each should 
bid God-speed to the other, extend the right hand of fellowship, glory 
in the achievements, and together wage the battle against the common 
enemy, ignorance and disease. 

If the allopathic system of medicine, since it has demonstrated, in 
various ways, its lack of faith not in its system, but in the curative 
value of its own medical therapeutics, would with all its wealth, influ- 
ence and power, assist the homeopaths to more fully develop their law 
of cure, and place their therapeutics on a more tangible and practical 
basis, a more brilliant and harmonious medical era would soon dawn to 
illuminate the hopes of suffering mankind. This desirable day can not 
be hastened by unwarrantable and inexcusable condemnatory remarks 
by us of the great work which that^gjreat system of medicine is accom- 
plishing. Unprejudiced, philanthropic, honest and sincere effort, in 
the interest of suffering humanity, regardless of " ism or pathy," must 
be the guiding spirit of the coming medical system. 

I have read somewhere of a branch to this great law of similia, which 
when applied always proved its truthfullness. It read something like 
this: l 'Though I speak with the tongue of men and of angels, and 
have not charity, I am become as sounding brass or tinkling cymbal. 
And though I have the gift of prophecy, and understand all mysteries 
and all knowledge, and though I have all faith, so that I could remove 
mountains, and have not charity, I am nothing. And though I bestow 
all my goods to feed the poor, and though I give my body to be burned, 
and have not charity, it profiteth me nothing. Charity suffereth long 
and is kind; charity envieth not; charity vaunteth not itself, is not 
puffed up, doth not behave itself unseemly, seeketh not her own, is not 
easily provoked, thinketh no evil, rejoiceth not in iniquity, but rejoic- 
eth in the truth; beareth all things, believeth all things, hopeth all 
things, endureth all things. And now abideth faith, hope, charity, 
these three; but the greatest of these is charity." 



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ISO THE CLINIQUE. 

LIGHT AS AH ADJUVANT IN THE TREATMENT OF 
TUBERCULOSIS. 

ANNA HURD, M. D., MINNEAPOLIS, MINN. , 

The study of light as a therapeutic agent is one of the most facinat- 
ing of pursuits, as rich in promise as in present fulfillment. To relate 
the achievements of the phototherapy of today would demand volumes. 
I wish to call your attention to its use in tuberculosis. A brief review 
of its physiological effects will serve to convince you of its theoretical 
value. You are acquainted with the irritant effects of sunlight upon 
the skin: (1) Dilatation of the blood vessels with increased perspira- 
tion. 2. Transudation of serum and blood coloring haemosiderin 
matter into the skin. 3. Desquamation. 4. Pigmentation of the skin 
as a protection against the chemical rays of the sun. 

The dilatation of the blood vessels is not merely a temporary effect 
but persists, as is shown by a more ready response to ordinary stimuli, 
compared to unexposed surfaces. 

Effects of light upon blood. — Blood and lymph serum are fluores- 
cent fluids, which proves their absorption of the more refrangible fre- 
quencies of light, as blue, violet and ultra violet rays. In fact blood 
filters out a large proportion of these rays, thus you see the reasonable- 
ness of producing ischaemia by pressure in the classical Finsen treat- 
ment of skin tuberculosis, in order to obtain deeper penetration of 
these the chemical rays. It is thought by those who have made a study 
of light that oxygen and the higher frequencies of light have an har- 
monious vibration and that this element is the chief filter of those rays. 
Experiments have proven that haemoglobin exposed to light parts with 
its oxygen much more rapidly than that which is kept in the dark; the 
reverse is also true it combines more rapidly with oxygen in the light. 
Thus you see the stimulus of light upon the blood stream is chiefly 
upon the red blood corpuscle; this means the impartation of a stimulus 
to the whole of the living organisms. This is proven by clinical obser- 
vations and experimental data. 

Effects of light upon the nervous system. 

" There is no natural phenomenon which produces so profound an 
effect upon the mind of man as his consciousness of light." Note the 
generally sad expression of the totally blind; also the change for better 
on bright days, in most patieuts suffering with chronic maladies. In 
large photographic plate factories where workmen are exposed for long 
periods to red light they become markedly excited; if that light is 



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THE CLINIQUE. 151 

changed to"green or violet they become quiet again. Delirium often is 
caused in eye hospitals by keeping patients entirely shut away from 
light. Many experiments upon animals proves its direct action upon 
the motor nervous system. Clinically it acts as a powerful nerve tonic. 

The effect of light upon metabolism. — In the study of the action of 
light upon animal organisms it was found that there is increase in 
weight of animals exposed to light as compared with those kept in 
darkness; tissue change goes on more rapidly in those exposed to light. 
As is shown by the increased oxidation of proteids this increase of meta- 
bolism is due to the increased oxydizing power of the blood and in- 
directly through the nervous system causing greater activity of all 
tissues. Clinical observations show marked increase of all functions and 
more perfect elimination; after exposure to light there is also a slowing 
of the pulse rate^but there is increase in its volume. The temperature 
rises from 8° to;10°, respiration is deeper and slower. 

Animals that are kept in darkness lose in the percentage of haem- 
oglobin as well in the number of red blood cells. The fact that sun- 
light does penetrate the tissues is proven by placing sensatised films 
in various locations exposing that portion covering film to light and 
noting the change in the chemical condition of the film. Such experi- 
ments have been made through the chest and hand, also in animals > 
the abdominal walls and various tissues. Thus the penetrating power of 
light has been amply proven. For an interesting and exhaustive study 
of these facts I would refer you to the writings of Dr. Finsen, also the 
work on Light Energy by Dr. Margaret Cleaves of N. Y. 

Bacteriologists will tell you that in the culture of the bacillus tuber- 
culosis if you wish to maintain its virulence you must keep the culture 
in the dark away from all sunlight. No country suffers in the same 
proportion from tuberculosis as the British isles. This is probably due 
to the absence of sunshine over prolonged periods together with un- 
favorable conditions of fog and dampness. 

Nature has supplied an energy so vast that all human effort, to ap- 
proach it in intensity falls far below our expectations, but that energy 
is given to us in such form that we, the unsatisfied, hurrying, striving 
midgets of the universe have not patience to use that most beneficient 
gift as we might — I refer to sunlight — owing to the customs and tradi- 
tions of these same midgets, precluding the possibility of their adopt- 
ing the costume that an illustrious humorist designated as a bead neck- 
lace and a palm leaf fan. To make best use of this sunlight expensive 
solaria must be erected wherein nude patients may be exposed to sun- 
light. 



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152 THE CLINIQUE. 

There are to be obtained three distinct effects from the use of sun baths. 
( 1 ) A tonic effect: short exposures of the entire nude body to the solar 
energy. (2) An eliminative effect: a long exposure without any at- 
tempt to minimize the thermal energy. (3) A nutritive effect: a long 
exposure modifying the temperature in order to best secure the chem- 
ical energy. 

The 3d is the one used by Dr. Finsen: In his sun baths the patient 
walked nude in sunlit yards where the skin temperature was kept down 
by sprinkling the ground, and if necessary shower baths were used. 

In the passing and repassing of the blood stream during a sun bath 
every drop of blood is brought under the influence of light and revivi- 
fied. Sun baths are of benefit: (l)-by increasing perspiration and 
other eliminative processes; (2) by stimulation of metabolism; (3) by 
stimulation of the nervous system; (4) by direct action on the blood, 
increasing oxidation; there is improvement of appetite, improved spir- 
its and better sleep. A few moments of such treatment will not suffice 
except in very weak patients, and they must be inured by gradually in- 
creasing the time; 2 to 4 hours is the average. Great good might be 
done in hospitals and sanitoria, or even homes, if tuberculosis patients 
could be lightly covered with white clothing or sheets, and, with head 
protected, the full length of the body exposed to sunlight on sunny 
porches or in south or east windows. This therapeutic agent is power- 
ful for good, not only in pulmonary tuberculosis, but in bone lesions 
and many other diseases of nutrition. 

Many methods have been devised to intensify the chemical action of 
the sunlight, and to use when Mother Nature sees fit to shut away its 
light. Among these are: (1) X rays; (2) arc light baths. Incan- 
descent light baths have not sufficient chemical intensity for this pur- 
pose. 

1. X-Rays. — The X-Rays have given the physician a very valuable 
means of diagnosing tuberculosis, both . pulmonary and bone, much 
earlier than by any other means; a cure of tuberculosis depends upon 
its early diagnosis. "It is desirable to diagnose a case before the ap- 
pearance of tubercle bacilli in the sputum and if possible before a 
cough manifests itself. n Most workers with X-Rays claim this can be 
done better with X-Rays than any other method. It certainly should 
be used as a confirmatory method. All who have tried X-Rays as a 
means of cure in this disease agree that it inhibits the tubercular growth 
and lessens its virulence; these facts place the method among the val- 
uable agents in the therapeutic armamentarium of the physician. The 
first effect upon the patient is to increase the sputum with looser cough. 



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THE CLINIQUE. 153 

better sleep, appetite and bowel function followed by gradual gain in 
strength and weight, and disappearance of bacilli from the sputum. 
Care must be used, for over exposure causes too rapid absorption of the 
waste products and toxemia results. In hemorrhagic cases X-Rays 
certainly and surely act as a haemostatic. 

The methods in use vary with the apparatus and operator. Dr. 
Burdick advises the use of a tube of such strength as will allow the 
light to pass through the chest without showing its structure. The 
best results are obtained in incipient cases. In those cases where the 
patients are men or women accustomed to out of door exercise and peo- 
ple with good recuperative powers also, a simple infection yields much 
better than cases of mixed infection. In my own experience I have 
had two interesting cases I wish to report. (1) A woman over 60 
years of age, a farmer's wife accustomed to much out door work; she 
had an afternoon temperature of 99°, cough, morning but quite con- 
stant, had lost much weight. Physical examination revealed- a slight 
dullness in left upper lobe, mucous rales all through the chest. Fluoro- 
scopic examination showed an area large as an orange in left lung cor- 
responding to dullness, tuberculous bacilli found in abundance in sputum. 
I gave the patient 3 treatments per week from June 16th to Sept. 11, 
29 treatments in all; at end of this time with fluoroscopic examination 
there was a very small area of consolidation or fibrosis visible, no signs 
on auscultation, no bacilli in sputum, she coughed little in the morning 
and had gained 10 pounds in weight. 

Case (2) A young lady 22 years of age — her father and one sister 
died of pulmonary tuberculosis, another sister had bone tuberculosis 
and recovery after amputation of forearm. My patient had an exhaust- 
ing cough, much pleuritic pain and bacilli abundant in sputum. She 
also had enlarged mesenteric glands and abdominal pain and frequent 
diarrhea, palpitation and irregular action of the heart, face pale and 
very sallow, weighed less than 90 pounds. I gave x-ray treatments at 
regular intervals during one summer and full four years ago. I also 
gave H. F. currents and general directions for diet, fresh air and nour- 
ishment and an occasional homeopathic prescription. There was grad- 
ual relief from pain, lessening of cough, disappearance of bacilli from 
the sputa. The patient had this spring an operation for appendicitis. 
There was no evidences of tubercular peritonitis or enlarged mesenteric 
glands. She is now living in fair state of health. 

The greatest difficulty I find in treating these patients is they rely too 
much upon the office treatment and will not or cannot follow other in- 
structions that make the treatment complete. 



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154 THE CLINIQUE. 

Arc light baths. — The arc light with iron or carbon electrodes and 
2000 to 20,000 candle power is a light very rich in chemical rays. A 
few institutions have made use of this fact and built bath rooms and 
cabinets where patients can be exposed to the light of from 2 to 4 
arcs; these institutions report many favorable cases. It is a powerful 
nerve tonic and has a marked stimulating effect upon plants as well as 
animals; its bacterecidal powers are greater than any other artificial 
light. It has proven a most valuable therapeutic agent for the treat- 
ment of skin tuberculosis in the hands of Dr. Finsen. In the arc light 
bath there is to be had all the radiant energy characteristic of the sun 
more concentrated* in the chemical end of the spectrum than the sun- 
light as it is not filtered through so great an air space. It has all the 
physiological effects characteristic of the sun. 

Notable physicians claim favorable results in pulmonary tuberculosis 
as diminution of the cough and expectoration, greater respiratory capa- 
city, quickened circulation and gradual improvement. Many cases of 
symptomatic cure. I wish to call your attention to the fact that no 
matter how valuable a therapeutic agent may be, if after an hour or 
more a patient returns home to unfavorable sanitary conditions, poor 
food, poorly prepared, there will be no response to that agent, or a 
very slight one. In all cases of tuberculosis insist upon sanitary sur- 
roundings, fresh air and good diet. It is best to supplement light treat- 
ment also and much benefit is derived from H. F. and static currents 
of electricity. 



PSYCHOLOGICAL SURGERY.* 

E. H PRATT, M. D., CHICAGO. 

Here are six statements which you will kindly correct or admit, as 
they deserve: 

1. All the bodily functions, except that of chemism, are accomplished 
by tubular action. We perspire by tubes; we breathe through tubes; 
our blood vessels and lymphatics are tubes. Tubes conduct the saliva 
into the mouth, the bile into the duodenum. The urinary apparatus 
is tubular from kidneys to urethra, and the sexual apparatus in both 
male and female is tubular in structure. In short, we perspire, we 
breathe, we circulate, we eliminate, we reproduce through the agency 
of tubular action, plus chemism. 

2. All tubes are operated by involuntary muscles. 

* Read before the Illinois State Homeopathic Society May, 1906. 



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THE CLINIQUE. 155 

3. The nervous force upon which their action solely depends is 
known as the sympathetic nerve force. Note, please, that the sympa- 
thetic nerve itself is by no means a source of power, but merely its 
transmitter. 

4. The life of the sympathetic nerve, or what we have called the 
sympathetic nerve force, is otherwise and commonly known as the sub- 
conscious mind. By some it is known as magnetism, by others as 
merely a form of electricity. Many are satisfied to know it as life. By 
some it is known as the soul. But it will be fair to all classes of think- 
ers if it is referred to as the sub-conscious mind. Its existence is 
readily demonstrated by the administration of an anesthetic or a nar- 
cotic, or in natural or hypnotic sleep, in any or all of which conditions 
all the faculties of the conscious mind are completely folded, which at 
the same time, under undisturbed sub-conscious influence, all the or- 
gans of the body still functionate; indeed, all the organic activities not 
dominated by consciousness remain undisturbed. This sub-conscious 
part of our natures is a fascinating and profitable field for study and in- 
vestigation, and is the part upon whose condition so much depends in 
all surgical practice. Sometimes this part of our nature is known as 
the spontaneous, involuntary or intuitive self. Nor is this such bad 
naming, for from this indwelling, unsensed soul of ours issues every- 
thing spontaneous that bubbles up into consciousness. Sometimes 
hopes arise within us, and sometimes- fears. Sometimes we are im- 
pelled to honest action, and sometimes our inclinations are in the op- 
posite direction. Sometimes we are impelled to speak the truth upon 
all occasions, and at other times lies become spontaneous. At times 
we love; at other times we hate. In short, all virtues may be spon- 
taneous, while at the same time vices enjoy an equal privilege. 

Now please do not find fault with my fifth proposition, at least with- 
out careful and just consideration. It is this: that the quality or con- 
dition which is spontaneous in our natures exercises a marked influ- 
ence upon all bodily functions, and through these, upon the tissue pro- 
ducts. 

6. If this is true, then states of the soul, or conditions of the 
subconscious mind, are responsible for both health and disease, for 
immunity and susceptibility, for bodily harmonies and for bodily dis- 
turbances. And as functions prescribe and dominate metabolism, we 
must look to the same source for our causes of normal structures and 
also for our pathology. In other words, the human body, at any time, 
be it sick or well, is nothing but an outer or physical expression of the 
inner or soul life. To the soul, then, or subconscious mind, must we 
look for the first cause of physical pathology. 



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156 THE CLINIQUE. 

All states of the soul can be fairly classified under one of two heads, 
the desirable and the undesirable. The desirable qualities are those 
that everybody welcomes and wants, and praises and delights to con- 
template. The lifet need not be completed, the mention of a few being 
sufficient to explain what is meant. Amiability is one; trust is another; 
love is another; honesty is another; truthfulness is another, and so on. 
All these sunshiny qualities exercise a benign influence upon all bodily 
functions and gladden the whole being with their health-giving influ- 
ences. 

Under this head are to be mentioned the antithesis of these qualities. 
These are irritability, hatred, jealousy, fear, sorrow, anxiety, greed, 
various lusts of the flesh, and all the unhappy sentiments that go to 
make up the shadow lists of soul qualities that are so easily recognized 
in other people, so unwelcome everywhere, and so appropriately men- 
tioned in the present connection, because their action on the delicate 
organism of the human body is to disturb its function and pervert its 
various uses and precipitate disease. 

Now while you may be willing to endorse all that has been said thus 
far, it will be quite natural for you to question the practical use all this 
has in surgical practice. Granting that it may account for the exist- 
ence of surgical diseases, what has it to do with their treatment? Simply 
this: the first cause of congestion, of disturbed function, of mal-nutri- 
tion, of all inflammation, of blootf poisoning, of neoplasms of all kinds, 
of perverted metabolism having been ascertained, is not the first duty 
of the surgeon to do all in his power to remove the cause? 

But how can a surgeon administer to a mind diseased? What if irri- 
tability does predispose to inflammatory action? What if subconscious 
fears do render the patient susceptible to blood poisoning? What if the 
various disorderly states of mind and morals do exercise a baneful in- 
fluence upon surgical cases? What has this to do with surgical prac- 
tice? Can a surgeon clear a patient's mind from unwholesome condi- 
tions and tendencies? Is he expected to patch lives as well as bodies, 
to exterminate spiritual as well as physical pathology? Is he called up- 
on to regenerate souls as well as accomplish bodily patchwork? Patients 
do not care to have their minds meddled with when it is their intention 
to employ merely a surgeon, do they? And even if the surgeon could, 
would it be right for him to tamper with the patient's interior life, 
when all he has been employed for is to accomplish physical relief? 

It is not the purpose of this paper to answer any 'of these important 
questions. Answer them yourselves, or get your patients to answer 
them, and of course serve them as they like to be served. Do merely 



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THE CLINIQUE. 157 

what you were employed for, and by all means escape mischief by a gra- 
tuitous meddling with conditions which you are not employed to con- 
sider. Of course in your surgical work you are expected to succeed. 
You are expected to succeed, and there may be some that will give you 
carte blanche to use your best efforts, employ your highest powers, and 
your lowest powers, and all the powers that may be necessary to accom- 
plish restoration to health. In such cased the best work of which you 
are capable will be in demand, and you will be permitted, and possibly 
entreated, to employ all the resources, mental and physical, at your 
command, that can in any way aid in the recovery of the patient. 
That such work can be done is true. That surgeons are capable of per- 
forming it is also true. 

How is it to be done; how the mind of a patient is to be cleared of 
its cess-pool of death-dealing influences; or in other words, the proper 
manner of applying curative psychological measures, is likewise foreign 
to our present purpose. It is enough for the present that the real source 
of surgical pathology receives the attention and appreciation which % it 
has so long merited, and just as long been denied. 

But the second part of our subject must not be neglected, namely, 
the psychological condition of the surgeon himself and of his aids is an 
element in the proper handling of surgical cases not to be denied or 
neglected if full justice is to be done the surgeon, the patient, or both. 

I wonder if surgeons realize that when a patient is under an anesthe- 
tic that it is only the conscious part which is sleeping, and the sub-con- 
scious part, which presides over the bodily functions, is still most 
thoroughly awake. I wonder, too, if you have ever thought that the 
condition of a patient under an anesthetic is practically identical with 
that of a hypnotized subject. When a subject is hypnotized he has 
withdrawn from the guidance and protection of his own conscious mind 
and submitted his sub-conscious self to the will of the operator, accept- 
ing him for the time being as his conscious self, ready to accept any 
suggestion which he may make, granting him complete obedience to 
even the most ludicrous and unreasonable ccmmands. The conscious 
mind of the operator, in other words, has been accepted as the con- 
scious mind of the patient, and whatever suggestions the operator may 
make will be accepted and acted upon by the subject. In this way 
hypnotists develop atrophied muscles, stimulate enfeebled functions 
and produee phenomenal physical results upon their subjects, although 
as yet it is more frequently employed for public exhibition of wonderful 
phenomena rather than for curative purposes. 

Now when a patient is under the anesthetic, the conscious mind is 



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158 THE CLINIQUE. 

completely off guard and the patient is in the hands of the surgeon, 
having accepted his services in complete trust and submission. The 
surgeon and his retinue of assistants really stand in the relation of a 
hypnotizer to his subject, and this places the surgeon in a doubly re- 
sponsible position. One is that he accomplish his physical work in a 
skillful and otherwise acceptable manner; and the other is that he main- 
tain such a mental and moral attitude that his influence over the sensi- 
tive subject under his control shall be helpful to the case. 

This is a phase of surgical practice that seems hitherto to have been 
overlooked, and yet its importance is not easily exaggerated. Psycholog- 
ical training as requisite for the highest type of surgical achievement, 
I think would be a new and startling, probably a ludicrous, idea to the 
faculties of a large part of our medical colleges at least. But the posi- 
tion taken in this paper may some time be recognized as important, and 
it undoubtedly will be later on. Nevertheless, to give the subject brief 
attention may help somebody and will hurt nobody. 

Now answer me this, please: Is college education detrimental to suc- 
cessful farming? Is it necessary for a carpenter or a blacksmith to be 
an intellectual or normal clodhopper? Is it possible for a perfect 
gentleman to perform a high grade of physical work of any kind? Is 
spiritual growth suicidal to the successful practice of any of the arts and 
sciences? Is it necessary to be a materialist in order to achieve perfec- 
tion in material work? Can one be philosophical and at the same time 
practical? Does thinking interfere with action? Does education of the 
feelings stand in the way of surgical technique? 

Just think of these questions and answer them today for the sake of 
the society, or at your leisure for your own sake. For myself, these 
questions are old ones and have long since been answered. You are 
•entitled to a statement of the results of my experience and observation 
as far as I have gone in this direction. This is not the proper time for 
a long report involving the details of illustrative cases. It will un- 
doubtedly be sufficient for now if the scope of the present paper is made 
to include a few general conclusions. 

First of all, let me state that throughout my professional life,I have been 
always more or less interested in the study of the soul and the great sea 
of the unknown in which it swims, but in my earlier professional years 
this was more a following out of a spontaneous tendency than for the 
purpose of acquiring a high grade of surgical accomplishment. Now 
it is both. However, the knowledge of psychology and the ability to 
apply it in connection with surgical practice is, beyond question, of in- 
-estimable value, especially in critical cases. If the pursuit of surgical 



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THE CUNIQUE. 159 

metaphysics were productive of inattention to the details of physical 
surgery, its utility might well be questioned, even though some valua- 
ble points might be gained thereby. I cannot speak for others, but for 
myself, such is not the case. I find myself just as eager as ever for 
added knowledge in everything that pertains to physical surgery; the 
lotions, the powders, the physical preparation of the patient, the care 
of the surgical field, the closing of wounds, the question of drainage, 
the use of anodynes, and all other subjects pertaining to the physical 
conduct of the case still impress me as being fully as important as I 
have ever considered them. As for the technique of the operative pro- 
cedure, I am glad to report that I find my surgical judgment improved, 
my sense of touch intensified, my hands constantly acquiring increased 
skill just in proportion as I am able to cultivate the garden of my own 
soul, weeding out the things that are undesirable, and cultivating those 
that are universally recognized to be wholesome and healthful. 

I know that fear kills more patients than surgeons do. Sometimes 
it is the fear of the patient, but the object of this part of the paper is to 
remind you that sometimes it is the fear of the surgeon, leaving un- 
considered the contagion which the surgeon exercises over his patients, 
especially when the anesthetic is being employed. Fear, entertained 
by the surgeon himself, makes him either too timid or too bold. It 
iinsteadies his judgment and prompts him to sins either of omission or 
commission. It is a prolific source of meddlesome, dangerous, dis- 
astrous and in every way unfortunate surgery. 

And fear is only one of the shadowy forces that stands in the way of 
good surgery, just in proportion as it has lodgment in the surgeon's 
consciousness. This fact leads to a very serious reflection. 

If it is true that surgical diseases have their incipiency in disorders in 
the internal life of the patient, are we not liable to find an excuse for a 
large part of the bungling, ill-timed, and otherwise mistaken and un- 
fortunate surgical practice in the untamed, untrained souls of the sur- 
geons themselves ? 

Metaphysics is not inimical to physics. Indeed, all practical meta- 
physical knowledge has its basis in an accurate or detailed knowledge 
of physics. The higher the tree grows and the broader it spreads its 
branches, the deeper its roots must penetrate the soil to render it sub- 
stantial and prevent its being so top-heavy as to be capsized by the vio- 
lence of the storms it must encounter. There is no excuse for rivalry 
between physics and metaphysics, for each is but an aid to the other. 

Certain it is that the practice of surgery will never achieve its acme 
of perfection until all physical technique and measures are supplemented 
by an equally extensive and practical psychological training. 



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160 THE CLINIQUE. 

Homeopathic surgery is a great step in advance of plain surgery. 
Psychological surgery is the next step to be taken in the progress of 
the surgical art. The psychological knowledge available for surgical 
purposes, both as regards the patient and the surgeon himself, is already 
in the world and at the command of the surjgeons. They need not hes- 
itate to avail themselves of the great privilege which this higher knowl- 
edge bestows, for they can be assured that their interest in physical 
science, instead of being disturbed, will be increased; that their oper- 
ative technique, instead of being harmed, will be helped. Their sur- 
gical judgment in all cases, instead of being detracted from, will be sup- 
plemented to a most satisfactory, as well as surprising extent. The 
scalpel will lose none of its cunning, but will only do less damage, and 
become surer and more effective in its work. 



THE SELECTION OF AN ANESTHETIC. 

T. E. COSTAIN, M. D., CHICAGO. 

The conscientious and careful surgeon takes pains in making his 
diagnosis and is usually not satisfied until he has had analysis of the 
urine, blood, etc. So too, the careful anesthetist will proceed carefully 
and cautiously in making a careful examination of his case before de- 
ciding on the anesthetic to be used. Let us imagine for a moment that 
the patient is before us prepared for a surgical operation and is turned 
over to the anesthetist. A glance at the patient will tell him many 
things he wishes to know, viz: age, temperament, color of skin, flesh, 
respirations, whether patient has a cold or cough, condition of the eyes 
and pupils, etc. Inquiry will ascertain if any foreign body is in the 
mouth. Notice whether the patient is a mouthbreather, and whether 
the tongue is enlarged. Examination will reveal the condition of the 
arteries, heart and lungs. Next he should examine the report of urine 
and blood, if made. If blood analysis is not made, he should satisfy 
himself by examination and observation whether anemia exists. When 
possible the history of the case should be looked over to see if the patient 
has been having attacks of nausea, etc. 

The anesthetist should ask the surgeon for his diagnosis and the 
probable chance of complications which may prolong the operation. 
The patient should be asked whether he or she has taken an anesthetic 
before and if so, what was its effect. In this way many accidents may 
be avoided. It should be his duty too, to assure the patient and control 
as much as possible the nervous element which is quite an important 



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THE CLINIQUE. 161 

factor in the management of these cases, both during, the anesthetic 
and in postoperative results. Whenever time allows the anesthetist 
should order that the patient be given from one to two glasses of water 
one-half hour previous to the time set for giving the anesthetic. 

Now in the selection of the drug to be used all of these factors must 
be considered: 1st, age. Children under the age of ten constitute ten 
per cent of the reported deaths from anesthesia and owing to the irrita- 
bility of the mucous membranes and the tendency to spasm of the 
glottis chloroform has given the best results, but even with chloroform 
we find the spasm of the glottis so lasting and profound that it requires 
infinite patience and a considerable quantity of chloroform to produce 
the necessary narcosis. Under such circumstances the warming of the 
chloroform by immersing the bottle in hot water, will be of service 
many times in controlling the spasm. I have had excellent results in 
anesthetizing young children with anesthol, the only disadvantage ob- 
served is that the patient regains consciousness too promptly to give the 
child an opportunity to adjust itself to the discomfort following an oper- 
ation. Infants and young children get very pale under chloroform and 
require the utmost watchfulness of the anesthetist. I have observed 
many times shock and a cessation of respiration in children from the 
removal of the foreskin and always make it a point to stop the 
anesthetic when the amputation of the foreskin is taking place. 

At the other extreme, old age, there are met with many conditions 
which should be considered. Old age is often the victim of pulmonary 
catarrh or emphysema both of which contraindicate ether as it is apt to 
give rise to serious or fatal bronchitis or broncho-pneumonia. Another 
condition often met with in the aged, arterio-sclerosis, or aneurism, 
should be given consideration as ether has a tendency to dilate the 
arteries which gives an opportunity for a rupture of the small vessels 
that may be the cause of considerable damage to the patient, perhaps 
fatal. I am not very prone to advocate stimulation during the course 
of an anesthetic, believing it best to leave stimulation to the judgment 
of the surgeon after his work is completed, but in the aged it is often 
wise, and indeed necessary, to use some form of stimulation should the 
operation be prolonged. Where the patient has Bright's disease the 
length of time of the operation should be considered. In short opera- 
tions chloroform should be used, as a small quantity will not as a gen- 
eral thing increase the irritability of the kidney, while the quantity of 
ether used will be greater and often increases the irritability of the 
kidney, but quantity for quantity ether is by far the less irritating of the 
two. 



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162 THE CLINIQUE. 

Temperament: Patients of the high strung nervous type take any 
anesthetic badly and are more prone to have some postoperative se- 
quelae. Nitrous oxide, or chloroform followed by ether have in my ex- 
perience been best in this class of cases. Patients of the plethoric type 
are apt to have a condition of cyanosis with a dusky hue to the skin in 
the early stages of anesthesia, not due to too much anesthetic but rather 
to too little. We have embarrassed respiration aud great care is re- 
quired in producing the proper degree of anesthesia. I have found 
that a change to chloroform for a time is essential to clear up these con- 
ditions and, just as soon as surgical anesthesia is complete, ether can 
again be resorted to with safety. The head in these cases should be 
held to one side, as it tends to relieve the embarrassed breathing. 
Women are better subjects than men, because they are more temperate 
and as a rule more susceptible and usually more willing to work 
with the anesthetist. The naturally placid temperament takes the best 
anesthetic, the nervous and hysterical being less susceptible, and furn- 
ish quite a percentage of our intoxicated cases. The nervous mechanism 
is so disturbed that many complications are apt to occur during the 
anesthesia, and usually results in nausea following it- 
General health of the patient. — Good health does not mean a safe 
anesthetic by any means; on the other hand, feeble health usually 
means perfect susceptibility, which means a safe anesthetic if not pro- 
longed. Strong, robust, athletic men whether alcoholics or not, are 
usually the most dangerous class of cases to anesthetize and a majority 
of the deaths from anesthesia is in this class of cases. 

The color of the skin. — To the experienced anesthetist the color of 
the skin means much; whether there is much color or little; it is the 
degree of change from the normal during the course of an anesthetic 
which tells how the patient is standing the anesthetic. Often the first 
change is noted in the skin, which is a warning sign to the anesthetist 
to examine the pulse closely. In the beginning of the impaired heart's 
action, one of the first signs of shock is the change in the skin color, 
followed by a cold sweat. The color of the skin before beginning the 
anesthetic has its significance as well; it is often the only way the an- 
esthetist has of knowing whether his patient is anemic or not and this 
means, as we will show later, the selection of chloroform as the anes- 
thetic, if possible. 

Respiration. — In mouth-breathers, or in those with closely fitting 
teeth, respiration is interfered with, and a small mouth gag should be 
placed before beginning. When the patient wears a set of false teeth, 
which has been removed, the lips may act as a valve and obstruct the 



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THE CLINIQUE. 163 

air, and here again a gag of some sort will be of benefit. Fixation of 
the lower jaw makes the anesthetic difficult and interferes with the res- 
piration. Enlarged tongne, or growths of the tongue, or in cases where 
the tongue is pressed tightly in front of the teeth, often so interferes . 
with respiration that a tongu$ depressor becomes necessary in order 
that inspiration of air be not interfered with. Growths of the neck, 
such as thyroid, enlargement, etc., obstruct respiration, and chloroform 
is usually best, although ether by the drop method is being brought into 
greater use for these cases. When we have disease of the larynx or 
trachea, chloroform should be selected. When respiration is inter- 
fered with by ascites or emphysema, great care must be used, and chlo- 
roform given early followed by ether. In these cases much of the dan- 
ger is avoided by aspirating the fluid a few hours before the anesthetic 
is given. 

If the patient has a cold or a cough, especially a recent one, chloro- 
form should be selected in order that bronchitis and bronchopneumonia 
may be avoided, it also avoids the abundant secretion of mucus, which 
is apt to cause a spasm of the glottis at any time during the operation. 

The eyes. — In addition to their value as a guide in administering an 
anesthetic, the eyes often give a line on the nervous state of the patient. 
Nervous or hysterical people'are apt to have a dilating pupil. I have 
seen in these cases one pupil dilated and the other contracted. Disease 
or deformity of the eye will often confuse the anesthetist unless he has 
familiarized himself with these conditions beforehand. Alcoholics 
when given ether are liable to have a dilated pupil during the entire 
course of the anesthetic due to increased irritability of the nervous 
system. If the patient is a mouth breather a small mouth gag should 
be placed before giving the anesthetic otherwise the amount of anesthe- 
tic vapor inhaled will be slow and the anesthetic state will be prolonged 
and tedious. In cases when the teeth are clenched or the tongue en- 
larged, a tongue depressor may be placed and held in the mouth to be 
used when necessary. This will many times save time in case of 
arrested respiration or spasm of the glottis. 

The urine offers many valuable suggestions. When the quantity of 
urine is greatly diminished with a low elimination of urea it is best not 
to operate until both the urine and urea has been increased. I have 
observed total suppression of urine follow cases of this kind from twelve 
to twenty-four hours after an anesthetic. From the inception of 
chloroform cases have been reported who die with anomalous symptoms 
some hours or days after inhaling chloroform. 

Recent investigations have given facts regarding these delayed 



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164 THE CLINIQUE. 

changes in the liver and kidneys from chloroform which bears on this 
subject. Guthrie, Carmichael and Beattie of England, Bauoler of 
Prague, ancl Beaux, Favill and Kelley in this country have made re- 
markable chemical observations. The pathological lesions are fatty 
changes in the liver, kidney (yellow atrophy) suprarenals and of the 
epithelium of the mucosa of the stomach. The symptoms appear after 
the patient has apparently recovered from the operation, shock and the 
anesthetic, are repeated vomiting of foul watery fluid, followed by what 
looks like dregs of beef tea, extreme restlessness, excitement amount- 
ing in some cases to delirium, alternating with apathy. Jaundice, al- 
buminuria and cylindruria are developed and death usually occurs on 
the fifth day and is due to cardiac and respiratory failure. This in 
some cases happens between the twelfth and forty-second hour after 
the anesthetic is inhaled. Although pyrexia and hyperpyrexia have 
been reported, they are not commonly associated with these cases. A 
subnormal temperature being usual, there is a distinct odor of acetone 
in the breath of patients and diacetic acid, acetone or both can be de- 
tected in the urine. 

Dr„ F. I. Dawson, writing on the alterations in the blood after an- 
esthetics, emphasizes the importance of limiting as far as possible the 
actual amount of anesthetic given the patient. In order to eliminate 
mere traumatism, Dr. Dawson compares the blood changes after frac- 
ture with postoperative changes. Leukocytes, polymorphoneuclears, 
and large mononucleated are more increased by operation under an 
anesthetic than in fractures; small mononucleated and eosinophiles 
were more diminished after operations. The leukoyctosis appears to 
be independent of the alterations in the red corpuscles. Chloroform 
is feebly hemolytic and ether is much more so. 



Iodipin in Acute Affections. — Some valuable clinical observations of 
E. Potheau demonstrate that the subcutaneous injections of iodipin are 
also to be recommended for acute affections, such as puerperal infection, 
erysipelas, typhoid fever, grip, eruptive fevers, peritonitis, broncho- 
pneumonia, etc. In all the cases seen, the intoxication was pronounced, 
the general symptoms more or less alarming, and the prognosis grave. 
After an injection of 15 Cc. (% oz.) the temperature dropped in about 
fourteen to eighteen hours, and there was a general amelioration of all 
the symptoms. In typhoid fever there seems to be a neutralization of 
the toxin, for the signs of intoxication rdpidly disappeared. The usual 
dose employed was 5 to 15 Cc. of the 25-per-cent. preparation. Pain 
or inflammatory signs were not observed at the site of injection. — Presse 
Med. % ipo6, No. ij. 



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THE \ CUNIQUE. M>5 

INJURIES OF THE ABDOMINAL ORGANS. 

O. A. PALMER, M. D., CLEVELAND, O. 

To define the extent and limitations of our subject, I will give the 
boundaries of the abdomen and state what it includes or contains sub- 
ject to injury. The abdominal cavity is bounded above by the dia- 
phragm, below by the iliac fossae and brim of the pelvis, behind by the 
lumbar vertebrae, and at the sides and in front by the abdominal mus- 
cles. This space contains the stomach, intestines, liver, spleen, pan- 
creas, kidneys, and their ducts, also the blood vessels, the trunk nerves 
and lymphatics. 

'Any injury, either internal or external of any of the above structures, 
and the most satisfactory treatment of the same will come properly un- 
der this title. The superficial wounds and contusions of the abdomen 
may be caused by blows, kicks, falls against protruding bodies, or by 
any body falling upon or passing over the abdomen, and by stab wounds. 

It is not always easy to determine the extent and danger of superfi- 
cial wounds and bruises of the abdominal walls. The circumstances 
under which these injuries are received, if they can be fully learned, 
should be considered and may enable one to make a more satisfactory 
diagnosis of the condition. It is possible for slight causes to be the 
means of dangerous results if the injured tissues were very much en- 
feebled before the injury. Severe hemorrhage may endanger the life 
of the patient at once, or if the case lingers for some time, small or 
large abscesses may form, which may seriously affect not only the gen- 
eral system but the internal organs. 

" In contusions, narrow bodies, the action of which is exerted on a 
small area, reach more deeply by overcoming the resistance of the 
abdominal parietes more easily than larger bodies. The resistance 
varies with the age, state of obesity and state of relaxation or contrac- 
tion of the muscles. The direction of the blow is of importance. If 
perpendicular to the deeper structures, it is most harmful; when paral- 
lel, it tends to glide off; when oblique, the force is modified.' ' (Dr. 
Demons. ) Blows upon the abdomen may affect the walls, the viscera, 
or both, and are always accompanied by more or less shock. A fatal 
result may follow without structural lesion. Death may result from the 
most trivial injuries and is probably due to reflex paralysis of the heart. 
The shock, which should always be carefully watched for, may pass off 
in a few minutes or hours, but if it does not it may prove fatal, or be 



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1 66 THE CUNIQUE. 

immediately followed by signs of hemorrhage or rupture of some hollow 
viscus. 

Abscesses of the abdominal walls, caused by injury, are characterized 
by the enormous amount of induration that surrounds them, and also 
by the fetid nature of their contents though they have no direct com- 
munication with any of the viscera. The skin injuries are no guide as 
to the extent of the internal injury, as the viscera may be extensively de- 
stroyed or reduced to a pulp with the skin showing no signs of bruising. 
Laceration of the abdominal muscles is not a rare thing and if it occurs 
immediately or soon after typhoid fever, tetanus may follow, owing to 
the degeneration of the contractile substance. The parietal and vis- 
ceral layer of the peritoneum may give way and be followed by perito- 
nitis. A slight degree of force may cause a rupture of any one or more 
of the viscera, especially if they have recently undergone any diseased 
changes, causing any degeneration of the structure. All the hollow 
Organs are in a more favorable condition for rupture if distended when 
injured. The stomach usually gives way near the pylorus. The small 
intestines are generally torn near the lower end of the duodenum. It 
is not an easy thing to diagnose many of these injuries and it i$ often 
necessary to wait for results to fully determiae the facts before any one 
can get conception of what has happened. The patient lies prostrate 
and generally it cannot be determined whether it is due to shock, 
hemorrhage, or rupture of one or more of the hollow organs, or all com- 
bined. If due to shock, one can be quite certain, as the temperature is 
the index symptom. In any case where the temperature falls one or 
two degrees, shock is present. The sympathetic and splanchnic nerves 
are closely connected with the medulla, which contains the automatic 
centers of these vital functions. This condition of the circulation and 
slow respiration prevents oxygenation and as a result we have a lower 
temperature, which is more marked as the injuries approach the stom- 
ach. Dr. Redard, of Paris, declared after careful observation of fifty 
cases from the battlefield, that a fall of temperature is a constant phe- 
nomenon. Every wounded man brought to the field hospital present- 
ing a temperature lower than about 96° F. will succumb, and conse- 
quently it is useless in such cases to resort to any operations. Every 
wounded man in whom a salutary reaction is not in direct proportion to 
the fall should be considered in a very serious condition. Penetrating- 
wounds of the abdomen produce an exceptionally low fall of tempera- 
ture, which is more marked as the stomach is approached. The pain 
as in all injuries to the abdomen mayor may not be an important factor; 
as I have seen under excitement, no pain for a time, even though the 



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THE CLINIQUE. 167 

injury be a severe one. The sensibility of the individual will govern 
the amount of pain, which is generally dull and tingling, but occasion- 
ally sharp and very hard to endure. 

Hemorrhage into the abdominal cavity may be determined by the in- 
creasing intensity of the shock and the yawning and jactitation of the 
patient, as well as by the dullness in the flanks, the level of which con- 
tinues to rise and varies with the position. In ruptures of the stomach 
or bowels, gas generally accumulates in the peritoneal cavity causing 
obliteration of the liver dullness. Where the stomach is ruptured there 
may be blood-stained vomiting, but this is not a certain symptom, as 
the mucous membrane of the stomach may be bruised causing hemor- 
rhage. If the intestine is lacerated, vomiting may occur, but the pass- 
age of blood per anum is more decisive. If the solid viscera, such as 
the liver, spleen, kidneys or pancreas are wounded, there is usually 
severe hemorrhage which should receive immediate attention. It is 
not always possible to check it, but catgut ligatures and sutures and 
gauze packing are the best means of relief. If the gall bladder is in- 
jured it should be sutured as the intestines are. If the ureter is injured 
and cannot be repaired it should be stitched into the wound or the kid- 
ney removed. The blood-vessels and nerves are important and should 
receive immediate attention as indicated. 

In all wounds that involve the parietal peritoneum and viscera the 
injured tissues should be thoroughly examined and cleaned and dealt 
with according to circumstances. There should be no hesitation in en- 
larging the external wound if there is not sufficient space, or making 
another if needed to do the work well. The omentum should be thor- 
oughly cleaned and if parts of it are injured beyond repair, they should 
be ligated in successive portions with silk, and removed, and when sure 
there is no bleeding, the remaining portion returned to the abdomen. 
All wounds in the hollow viscera should be made secure by sutures. 
All small punctures or openings are usually plugged by the prolapsed 
mucous coat, but it is not best to trust to this and it is much better to 
evert the edges and unite the serous surface with Lambert sutures. Con- 
tused wounds may be sutured so long as the internal diameter of the in- 
testines is not reduced to one-half its normal size. Sometimes owing 
to the amount of bruising, or the situation of the injury, or if there is a 
number of wounds close together, it will be safer to resect the injured 
portions, or establish an intestinal anastomosis. Grafting the bowels 
together is not so easy as anastomosis, nor as safe. If the patient's con- 
dition will not allow a prolonged operation an artificial anus must be 
made, the two ends being adjusted side by side, so, if recovery takes 



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168 THE CUNIQUE. 

place a further operation can be performed to repair the bowels. If any 
of the contents of the hollow organs, foreign substances or a large quan- 
tity of blood has entered the peritoneal cavity, it should be carefully 
cleaned with warm water ( 105° F. ) or with water and any harmless anti- 
septic. While doing this it is well to move the bowels gently with the 
hand, so that their whole surface may be properly cleaned and it is not 
best to use a drainage tube. 

At this point allow me to quote from a late writer, as he well handles 
the usual happenings after these operations: " We are sometimes as- 
tonished at the rapidity with which the abdomen becomes distended, 
and we at once perceive this condition to be one of pressing danger to 
the patient. The diaphragm will not descend and the respiration is 
therefore imperfect. The cavity of the abdomen possesses only certain 
dimensions; its capacity for containing the inflamed bowels without 
angulating at the return of the convolutions is limited. These angles 
must be acute and sharp, so that the bowel is effectually obstructed as 
completely as in hernial protrusion with strangulation. Now will fol- 
low eructations of air, then colorless fluid, then colored mucus with bile 
growing constantly greener and darker, showing that the work of mis- 
chief is complete. Obstructions of the bowels cause between one and 
two per cent, of the deaths following laparotomy. The majority of 
these cases are, perhaps, dependent upon mechanical causes — adhe- 
sions, etc., but some are due to paralysis of movement of the intestines, 
following sepsis or injury, to the nerve supply of the muscular coat. 
How can we distinguish clinically the various forms of intestinal ob- 
structions? In the differential diagnosis we may note the following 
points in a case due to paralysis-mode of onset is not definite. A rigor 
may usher in peritonitis, but not an obstruction. The temperature in 
serous inflammation is often subnormal. This is rare in strangulation. 
Here we must ask ourselves what is the seat of the disease? Is it in 
the larger or smaller intestine? 

In obstruction of the small intestine — 1. The pain and other symp- 
toms are more acute and the course more rapid; 2. Vomiting is early 
and urgent; 3. The urine is scanty; 4. Distention is early but not ex- 
cessive and affects the small intestine alone. The obstruction of the 
large intestine — 1. The pain and other symptoms are less acute and the 
course more gradual; 2. Vomiting is long delayed or of but little sever- 
ity; 3. The urine is abundant; 4. Distention occurs only after an in- 
terval, but reaches an extensive degree and affects especially the larger 
intestine, so that the transverse colon may be seen crossing the upper 
part of the abdomen, and there is fullness in one or both loins. The * 



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THE CLINIQUE. 169 

treatment is the difficult part of this subject. Enforce the stoppage of 
fluids of all kinds by the mouth. In the consideration of the specific 
treatment we must bear in mind that there is complete arrest of the 
peristaltic -action and this must be reestablished if possible. We must 
also look to the soothing of the excited sympathetic. Get rid of the ir- 
ritation. " Would you operate? If you do you will be disappointed to 
find the procedure quite useless. It cannot restore the lost tone of the 
intestine. How fashionable it is to operate in every case of intestinal 
obstruction, to perform surgical feats, often making the death-bed the 
field for surgical display." (Dr. Myers.) 

During the last fifteen years it has fallen on me to treat several cases 
of abdominal injury and I will relate the history of two of them. Case 
1. Mr. D — while blasting rock, supposed the fuse to be extinct, and 
having waited the proper time, concluded he would draw the charge 
and try again to explode it. As he was about to remove the charge 
and was bending over it the explosion took place. I cannot describe 
the condition in which I found him; certainly this is the worst case I 
have ever seen or heard about, and I can only give the general facts. 
He was thrown into the air about fifteen feet and when the workmen 
got to him was semi-conscious. He was not just certain what had hap- 
pened and wished to be taken home, where I found him about two 
hours later. His clothes were as black as powder and completely torn 
to pieces. His skin and every exposed part were colored black with 
powder smoke. His feet and legs below the knees, were not injured. 
Both legs, from the knees to the body, were badly lacerated and pieces* 
of flesh as large as a man's hand were never found. These three or 
four large wounds and a large number of smaller ones made up the in- 
juries of the legs. One testicle was destroyed and nearly all of the 
scrotum was taken away. The abdominal wound was severe. The 
accidental celiotomy was not nicely done. Whatever made the incis- 
ion tore the flesh badly and left a very unsatisfactory wound to close. 
The opening into the abdomen extended from the pubic bone on the 
right side, upwards and outwards to the short ribs, through which the 
bowels and part of the liver protruded. The abdomen was filled with 
sand and dust; the bowels were colored with powder smoke, and full of 
fine gravel punctures. The liver had some gravel in it. The body 
from the navel up was not much bruised. The underside of the arms 
from the elbows down was severely injured. A portion of the skin and 
flesh was gone, and what flesh was left was full of sand and gravel. 
The hands were in the same condition. I removed two fingers from 
one hand. 



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170 THE CLIN1QUB. 

The neck and face had many small injuries, and had three or four 
ugly wounds, on one side a small stone lay on the carotid artery, on 
the other side a large quantity of the flesh was carried away. The scalp 
wounds were slow to heal. The treatment consisted in doing the best 
I could without any knowledge of abdominal or intestinal surgery, or 
any of our present day appliances. The clothes were removed and the 
body cleaned as best as it could be, but the black skin could not be 
made fully white again. The open wounds could not be rendered 
aseptic. The abdominal wound was a great thing to me, as I had never 
seen such a case, nor had I read of anything like it. This patient 
weighed over two hundred pounds, and was one of the strongest men I 
had ever seen. "He would not take an anesthetic to have his wounds 
dressed, nor did he at any time order me to cease work or show any 
signs of pain. All the limb wounds were cleaned the best that impure 
water and impure vessels would allow, and every foreign body removed 
that could be discovered. I left the wounds open and dressed them 
with camphorated oil. Nature did her best to heal the parts and suc- 
ceeded admirably; now and then I would find a pus cavity and remove 
a foreign substance of some kind. The abdominal cavity was cleaned 
with the same impure water, and all that could be was removed from 
the cavity. The intestines were cleaned, and the sand and gravel holes 
allowed to have their own way. For fear my patient would have pain 
after dressing, I gave him a dose of morphine. This dose, together 
with nature's power to contract the tissues around the openings, I have 
always thought prevented leakage into the abdomen; possibly there 
might have been some leakage as the lower angle of the external wound 
was left open for drainage, which was a lucky hit, as nature threw off a 
great deal of sand and bad material. For two weeks the bowels did not 
move, which gave them time for repairs. In about a month the open- 
ing into the abdominal cavity healed, and my patient was able to sit 
up in bed; in five weeks he could get to a chair nicely, and in six weeks 
walked about the house. The wounds of the legs and arms did not 
fully heal till the end of the third month. All that was left of the re- 
maining testicle was removed, and the remainder of the scrotum used 
to cover the wound which healed kindly. In six months this patient 
was practically well and concluded he had had enough railroading, so 
he went to his people in Philadelphia, where the last I heard of him he 
was handling trunks for a large hotel. 

Case 2. Mr. S — while going between two freight cars to make a 
coupling slipped and fell in such a manner as to be thrown between the 
drawheads which hit him about the middle of the abdomen and imme- 



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THE'CLINIQUE. 171 

diately opposite on the back. The force was so great that both sides 
were torn open, allowing the bowels to protrude several inches from 
each wound. In about two hours after the injury I examined this case 
in a freight car and found him pulseless. The shock was very severe 
and I am fully satisfied that the temperature was subnormal 2° or 3° 
F., but this was before our knowledge of this very important fact, so 
that we were unable to gain any information from this source. His 
condition generally was such that I felt certain he would not recover 
but thought it best to clean the bowels and return them to their proper 
place. It was during the washing and handling of the bowels when 
pulling upon them that I noticed the change in the respiration. In 
short this case gave a full picture of severe shock and in spite of every 
effort to effect a recovery he declined and died in about twenty hours. 
During twelve years' service as railroad surgeon I did not see a case as 
severe in every particular as this and it was the most instructive one of 
all. Shock was the cause of death, but during the time he lived after 
the injury, nature did much to cause a rally. His respirations were 
greatly increased and were much faster when the bowels were pulled on 
or severely handled. In all of this class of cases, if there is an increase 
in the respirations to 25 or 30 per minute, with hyperesthesia of the 
abdomen and cold extremities, if the shock has not reduced the tem- 
perature more than 1° to 1^° P. an operation is indicated. 

Abdominal section is the only treatment to apply in contusions of the 
abdomen. It has been sufficiently demonstrated that the symptoms 
are not an adequate index of the quantity of the lesion or lesions, and 
if we cannot tell what the injuries are, the only thing to do, is to in- 
vestigate and never wait until peritonitis arises before doing the opera- 
tion. 

As the result of a clinical and experimental research on this question, 
Gaub notes that the absence of a peristaltic sound after trauma is not of 
sufficient value to determine a celiotomy, but that if all means have 
been instituted to combat shock, and the pulse-rate is rapid and of nor- 
mal volume, and the peristaltic movements are absent, at the end of 
four hours, exploratory celiotomy is justifiable. 



A fluctuating swelling appearing between the ribs may, of course, be 
tuberculous or syphilitic in origin, but it may also be an extension of an 
intrathoracic growth, e. g. % dermoid cyst of the mediastinum. In all such 
cases, therefore, a careful examination, by auscultation and percussion 
should be made. — American Journal of Surgery. 



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THE C LI N.I QUE. 



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gditorM, 



Traveling too Past. — Railroad accidents which result in the loss of 
life are so common nowadays that we are not always sufficiently 
shocked to keep the horrible lesson of the error before us for any length 
of time; but this recent calamity on the New Haven road where elec- 
tricity was being tried as a motor power in place of the steam engine 
has indeed shocked the world. This misfortune was not the result of 
a broken rail, a disarranged switch, or did it arise from any mechanical 
defect or operative irregularity; it was due to the high rate of speed 
alone. In this instance the cars were literally whipped off the track by 
the terrible velocity and many of the unfortunate passengers were 
ground almost to fragments. Of course it is too late to talk about 
blame and it does little good after all; the fault really was not with the 
engineer who drove the motor at such terrific speed, for he was only 
obeying orders to annihilate time and in this he included a few lives 
as well. No, it is not the engineer, the motor or the track which we 
should blame; pur complaint can only rest against the mad desire for 
more speed; the " twentieth century " steam engine is too slow now 
and we must call in the aid of electricity for our fiendish rides; we 
must reach our destination in unprecedented shortness of time or we are 
not satisfied and the transportation company will lose our patronage; 
in all probability when flying machines become too slow we shall de- 
mand that we be blown violently through a tube to reach a destination, 
even though we lose consciousness in our travels. 

Will the American people never reach the limit in this time annihila- 
tion madness ? Shall we never be satisfied with the slower train which 



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THE CL1NIQUE, 173 

bears us . safely, if not so quickly, through space ? In other words, 
shall we ever quiet down and let well enough alone and live in a saner 
mood? No one can answer us yet and for that reason it is to be ex- 
pected that for some time to come we shall continue to fly about with 
our heads off and our limbs dismembered just to get ahead of someone 
else. Men are not content to be millionaires; they want the multi pre- 
fix; the idea now is not to do one thing well but to do many things at 
once and thereby increase our hysterical symptoms and get knocked in 
the head rather than die a slower and more . natural death. We have 
forgotten the story of Mr. Robinson riding slowly into Boston in the cool 
of the evening; we want to kill the horse at the outset, buy a new one 
at each mile post and then fall in a state of catalepsy as we land on all 
fours at the end of our journey. We must beat someone if we have to 
kill ourselves in doing it. This is indeed a new century and we must 
make it hum if the wheels do come off. We must drive the automobile 
like wildfire if we do kill everyone who gets in front of us and then 
dash over the precipice. Small numbers don't count in this genera- 
tion; we must multiply our hazards and subtract our safeguards in or- 
der to accomplish the apparently impossible. Let the man with a dan- 
ger signal step aside; the extreme must now prevail if we do break our 
necks. There is no time now to sit down and think; there is no op- 
portunity to put on the brakes; we must be in a constant state of unrest 
and then suffer with the nightmare if we. ever go to bed. We want 
rapid friends as well as a rapid gait. Calmness is a negative quantity 
and when our hair has turned gray we may perchance quiet down long 
enough to view the wreckage and if by chance no one is left to continue 
the wild race we may have a few saner moments for reflection. Then 
and only then shall we be able to learn what the strife is worth after all. 

h. v. H. 



Asylum Clinics. — There has been much controversy of late relative 
to the clinics which have been held in the Elgin asylum, and as usual 
the politician has come forward for the people. It seems that Dr. Pod- 
stata, the superintendent, had asked the members of the Fox River 
Valley Medical Association, and other students of medicine at various 
times to observe and study some of the interesting cases under his 
charge. • The speaker of the Illinois house of representatives not long 
ago introduced a resolution which in substance condemns this proced- 
ure, holding, as he does, that it is not the purpose of these institutions 
to be used for clinics or technical study. While these high sounding 



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i;4 THE CLINIQUE. 

phrases may be of good intent, they certainly seem to be academic and 
we can almost hear the vote-getting sound in their utterance. 

The laity seem to have a peculiar hatred of anything clinical where 
the patient is being used as an example for instruction and perfection 
in our science, which they are only too willing to call to their own aid 
in case of dire emergency. We heard the same objections to the use of 
the unclaimed dead when, in the interest of science, the medical frater- 
nity desired to use these subjects for the sake of required medical and 
surgical demonstrations. The poor tramp was kicked about the coun- 
try while he lived, but the moment he died the u critics " rose to his 
protection and put a halo over his body. We have no desire to de- 
throne this respect for the insane, the dead or the living, but if these 
restrictions are to continue where are we to get our medical and sur- 
gical knowledge which the public demands ? How in the world is a 
physician to get any practical clinical knowledge if we do not have 
diinics? And where will we conduct clinics, on insanity for instance, 
if not in the asylum? 

There is much foolish speculation about the propriety of things and 
some would have no such things as clinics where the poor may get the 
best of medical ability without price; they forget that in the majority 
of instances free patients are only too glad to be subjects for demonstra- 
tion and for that reason our clinics are overcrowded and much good is 
being done daily by this means. How shall a physician learn about 
insanity if he does not find this knowledge in an insane asylum? Fur- 
thermore what oifense can there be to the patient of unbalanced mind ? 
No physician or surgeon of modern day conducts a clinic of any kind 
without the most modest consideration for the patient's feelings and it 
is not right to infer that these clinics might be criticised in that re- 
spect. Our State Board of Charities ought not to be hampered in that 
respect; this board evidently considers both sides of the question; they 
know the needs of these patients and the needs of patients in all our 
charitable institutions. It seems to us by far better to trust a decision 
of this kind to such a body as this than to leave it to the emotions of a 
political assembly. If the Legislature is after reform why not look 
closer into the appointment of attendants in these institutions? Have 
we not heard some complaints in this regard ? 

The medical profession deserves better support than this; above all 
it deserves more respect. If there is any wrong being done by these 
clinics let us look into it and correct things, but by all means give us 
more clinics of all kinds. H. v. H. 



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THE CLINIQUE. 175 

Worthy of Consideration. — The homeopathic school has for some 
years been in a transitional stage which has given rise to much uneasi- 
ness on the part of some of its members, while others have endeavored 
to discover towards what this transition is tending and have endeavored 
to harmonize with the inevitable, others have been absolutely indiffer- 
ent or have openly left the ranks of homeopathy. Belonging to the 
first class are the so-called " simon-pure homeopaths," who have never 
looked forward farther than the teachings of Hahnemann, and who be- 
lieve that all there is of therapeutic truth is contained in his writings. 
The second group mentioned have taken a broad view of the science 
and art of medicine and have believed and taught that truth is not the 
possession of any one group or time, and that it is progressive. In such 
belief they have endeavored to bring the teachings of Hahnemann 
in harmony with the great discoveries since his day. They 
have sincerely tested his teachings and those which harmonized with 
modern science they cling to with unshaken faith. 

Between these groups there exists considerable discord, which does 
no good to the cause of homeopathy. While we are squabbling among 
ourselves as to who is true and who is false, the dominant school is 
making great advances along the very paths that we ought to be tread- 
ing. While they are giving little credit to homeopathy or to Hahne- 
mann, they are really doing the most scientific and progressive work 
for homeopathy, and are doing more than is the homeopathic school to 
•disclose to the world the truth and brilliancy of Hahnemann's work. 
While we have complacently rested and congratulated ourselves that 
the law of similars belongs exclusively to us and is the non plus ultra 
of therapeutic truth, they have by various routes discovered how the 
law operates and have given us antitoxin and the various vaccines which 
are working and will work, marvellous havoc on disease. 

Gay, in February Hahnemannian Monthly, in an article entitled 
44 Present Day Iconoclasm in Medicine. What it means to Homeo- 
pathy," ably discusses this question, and says: 

Needless to say, this treatment has been practically abandoned, at 
least in this form. Nowadays old-school periodical literature is filled 
ivith articles on intoxication and immunity; how to produce immunity; 
how to eliminate or prevent the formation of toxines. We read of 
"vital resistance " and how to stimulate it. Studies in the blood have 
revealed the fact that the resisting power of the blood is not always the 
same. We find that the blood may be changed so that we can cultivate, 
as it were, a specific resistance to certain toxines. We find that leuco- 
cytes are sometimes much more active than they are at others. We 



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176 THE'CJLINIQUE. 

find that this activity can be raised by injecting intcTthe blood certain 
substances called vaccines, which are simply an emulsion of sterilized 
cultures of the specific germs against which we are directing our attack. 
Ten years ago, if any one had suggested to the old-school authorities 
that a boil, we will say, could be effectively treated or a spreading in- 
fection could be favorably influenced by internal medication or by any 
substance injected into the blood outside of general stimulants, the idea 
would have been scouted. The homeopaths were ridiculed for prescrib- 
ing the " hair of the dog that bites you." At the present time the old 
school are prescribing not only the u hair," but the "dog." 

In my opinion these studies in the opsonic index have done more to 
clear up this matter of specific vital resistance to disease than has been 
done since the time of Hahnemann. What he saw by instinct a hun- 
dred years ago is being laboriously proven in our laboratories. What has 
been called the monumental achievement in medicine in the last fifty 
years — I refer to the discovery of anti-toxin — is based upon the same 
principle. 

We find also under discussion at the present time much, both in text- 
books and in scientific monographs, concerning auto-intoxication and 
its relationship to disorders of metabolism and digestive disturbances. 
It seems as though, while all our acute diseases are manifestations of 
intoxication, introduced from without the body, all our diathetic dis- 
eases are coming to be considered as manifestations of auto-intoxication. 
There has been carried on in France a series of experiments showing 
that metabolic activity can be increased by the giving per-oram, or hy- 
podermatically, small amounts of enormously diluted solutions of the 
chloride of gold, it being claimed that one part in a million is suffi- 
ciently strong to, in some cases, double the amount of the excretion of 
uric acid in twenty-four hours. It may be truly said that the truths of 
homeopathy are being proven by its enemies. 

What do these things indicate? If they mean anything at all, they 
mean that we are on the eve of a revolution in therapeutic methods, at 
least as far as the giving of drugs ia concerned. 

It may be well for us to consider for a moment, as best we may, what 
apparent effects this change in thought has had, up to this time, upon 
old-schoool practice. In some quarters we see an intelligent inquiry into 
homeopathic methods. The old school is not wholly composed of fools 
and scalawags — we find that Koch, of Berlin, states that tuberculinuin 
in large doses aggravates tuberculosis; in extremely minute doses it 
helps to cure the disease. This sounds like an extract from Hahne- 
mann's writings on the nosodes. We find Behring, that great expert 



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THE CLINIQUE. 177 

on anti-toxin, acknowledging in several of his essays, what he calls 
"a homeo-therapeutic method of administering drugs," meaning by 
that what our old-school friends in this country call the "tonic" 
effect. 

The prospect of the old school taking up the work of therapeutic re- 
generation is remote indeed. They claim that if any changes in the 
materia medica are to be made, they are the ones to do it. Looking 
over their past record, I would prophesy that except in a few isolated 
instances they would make as little change in their methods in the next 
fifty years as they have done in the last fifty years. They are so 
wedded to empiricism that their minds are in no condition to accept any 
other method of drug prescribing. When they see the results of 
homeopathic prescribing forced upon them they are sometimes willing 
to make a test of the drug or drugs themselves. If they do, they do it 
empirically, never acknowledging that there is any reason for so pre- 
scribing, never giving us one iota of credit for presenting the drug to 
them. I have never met a single old-school prescriber, nor, with few 
exceptions, have I ever read an article in an old-school journal or book 
that showed the slightest knowledge of homeopathy. 

As I said before, I believe we are on the eve of a therapeutic revolu- 
tion. What front does the homeopathic profession present in this 
crisis? In the first place, we are divided into three classes: The first 
consisting of the optimists and pessimists that I mentioned before. 
These men actuated by diametrically opposite ideas, are both ready to 
desert the standard of homeopathy, to fly to the arms of the old school. 
To such I would call to mind the old story of the lamb and the lion ly- 
ing down together, but with the lamb inside the lion. Then we have 
our high potency friends, who by their obstinate bigotry would have 
killed homeopathy long before this if she had not had, like the prover- 
bial cat, nine lives. Fortunately, the high potency class is becoming 
smaller in number all the time. We have in the other class, the ma- 
jority of the profession, who might be called the " third estate," or the 
middle-of-the-road homeopaths, who recognize the fact that the physi- 
cian has not done his whole duty when he has made a homeopathic 
prescription, and do not hesitate to use adjuvants or palliatives when 
they are indicated. Upon this class will devolve the duty of carrying 
the homeopathic banner in the future. I realize that I am treading on 
somebody's toes, but I am here to voice the truth that is in me, and I 
am voicing that which the majority here present know in their heart of 
hearts to be true. 

What, then, is the duty of homeopaths in this emergency? For 



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178 THE CLINIQUE. 

emergency I verily believe it to be. I would say, too, that I believe 
this emergency is an opportunity that has never come to us before and 
may never come again. By that I mean that the brightest minds in the 
old school feel that their therapeutic methods must undergo a change 
and I believe that their influence, coupled with ours, may lead the rest 
of the profession onto the right track, but to do this we must present a 
united front. I believe that there can be, and should be, something 
done to establish a more definite dosage for homeopathic materia 
medica. It is not reasonable to suppose that the human system would 
react the same to identical doses of roasted oyster shell and prussic 
acid. The majority present here tonight know that the system does 
not react the same to all medicines in the same dose. It seems to me 
that if this matter could be settled, even approximately, that a great 
stumbling block would be removed. Again, our homeopathic materia 
medica, couched, as it is, in archaic language, classified in artificial 
classification, loaded down with useless symptoms, vertigo, for instance, 
is not in a form to appeal to the modern scientific mind. Homeopaths 
are used to it; they know nothing different, and they make it do. I be- 
lieve that if our polychrests could be reproven with the aid of modern 
methods of precision, that another great stumbling block would be re- 
moved. These things do not come about spontaneously. We must 
take definite action if anything is to be done. The American Insti- 
tute of Homepathy is engaged in re-proving the materia medica. I be- 
lieve a copy of their proving of belladonna, which consumed a year's 
time, is on sale for five dollars. At that rate the work maybe partially 
done twenty-five years from now. Such a materia medica would, I 
presume, cost in the neighborhood of three hundred dollars. Truly a 
broken reed in time of trouble. I see no reason why our homeopathic 
colleges should not be reproving drugs all the time. The students 
would be glad to enter the proving class for the price of their tuition. 
Ten or a dozen such provers in each college could be kept busy without 
placing any undue tax upon the capability of the institution. 

Our attitude in this matter should be one of dignified adherence to 
principle. We do not have to cringe before the old school. We do not 
have to hold on the coat-tails of any individual or individuals in the 
allopathic ranks. We hold the key to the situation. The scientific 
materia medica of the future must be the homeopathic. If it is ob- 
tained by the old school they must do one of two things: Either they 
must take it from us or they must do the same work that we have done 
in the way that we have done it. We have stood solid as a rock from 
the first. We have seen our remedies taken up by the old school, used 



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THE CUNIQUE. 179 

according to their methods, thrown out as ineffectual, or dangerous, 
forgotten, taken up again, used the same way, forgotten again, taken 
up again. I refer to aconite, which the allopaths are again using ac- 
cording to our indications in. our dosage, and they are satisfied with it. 
So do onr provings and methods stand the test of time. This game 
that the dominant school has forced upon us for a hundred years is 
about to come to a close and, gentlemen, we hold the trumps. Have 
we the nerve to play it to the end? 



Medical Education of the Laity. — A large part of every busy doctor's 
time is given to the wearisome work of combatting the silly notions 
that still prevail in the public mind regarding the subject of disease. 
No doubt these are mostly inheritances from the wierd pathology of 
former days but some of them are purposely fostered by the charlatans 
who still feed upon popular ignorance and credulity. Between the two 
the honest doctor has a large task getting rid of the grandmother no- 
tions and denying the statements made by famous "specialists" in the 
Sunday newspaper. 

Much time and energy goes in this way that might be spent in effec- 
tive practice could all this be avoided. If when little Willie needs his 
"tonsils cut" the doctor could go ahead and "cut" them without ex- 
plaining to Willie's papa and mamma and auntie and cousin that it would 
not cause either epilepsy or consumption it would be less labor for the 
doctor and might in the end be just as well for Willie. If one could 
prescribe for a common indigestion without going into the merits of 
liquozone for cancer or peruna for "catarrh" much valuable time would 
be saved. At present, however, these things cannot be and the doctor 
has to go back over the old familiar ground with each new patient who 
jingles his bell. 

The question is, can't we do something collectively to lighten this 
immense individual load? Why not begin an organized campaign of 
education, and do in a wholesale manner what each has to do for him- 
self? In a certain small way this has already been attempted. The 
subject of tuberculosis is now being put before the public in such a way 
that many of the older fallacies are disappearing, and it is possible even 
that the number of quacks' victims is a trifle less in consequence. 

Why might not other medical subjects be handled in a similar way 
to the advantage of everybody ? One of the medical societies of Chi- 
cago has tried the experiment of holding certain meetings to which the 
public is invited, and the result has been apparently beneficial. 



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180 THE CLINIQUE. 

This is a work to which some of the societies of our school could turn 
with profit. There are many subjects of general interest that could 
properly be presented in this way, and indeed why not the subject of 
homeopathy itself? Freed from its barnacles homeopathy in its broad- 
est sense could be presented to the non-medical public with interest and 
benefit- There is nothing occult about it, and no technical training is 
required to understand its fundamentals, while its reasonableness ap- 
peals to any intelligence not biased by tradition or prejudice. 

A saving of time and energy would result here, too, for we might 
less often hear the old story about the drop of medicine in Lake Mich- 
igan. B. H. 



Jfotieties. 



The Englewood Homeopathic Medical Society met at the Hotel 
Julian, March 12th, and the following program was presented: 

A Report of the Methods Employed in the Treatment of Tuberculosis 
at Dunning Hospital and in Norwood Camp, Dr. Pauline S. Smith. 

Similia Similibus Curantur Corroborated by the Findings of Modern 
Science; Dr. A. C. Tenney. Discussion opened by Dr. J. W. 
Hingston. 

A good meeting was reported. 



THE HAHNEMANN MEDICAL ASSOCIATION OF LOUISIANA. 

The Hahnemann Medical Association of Louisiana met in annual ses- 
sion with a good attendance from the city and country. Dr. C. R. Mayer 
presided. The secretary's report showed progress and interest along 
medical lines. 

The Chairman on Medical Transactions, Dr. E. Harper, reported all 
papers read before the society had been published. 

The Clinical Committee reported all departments working at the dis- 
pensary, good results had been accomplished, and that the department 
of dentistry had been added with Dr. E. Belden in charge. 

Drs. E. Harper and G. Aiken were elected delegates to the American 
Institute of Homeopathy and Dr. R: Moth to the Southern Homeopathic 
Medical Association. 

The president delivered his annual address, and the following papers 
were read: 



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THE CLINIQUE. 181 

The Use of Dental Antiseptics, Dr. E. Belden. 

Electricity as an Adjunct in Treating Diseases, Dr. R. D. Voorhies. 

A Plea, Dr. John T. Crebbin. 

The following officers were elected : 

President — Dr. C. R. Mayer, New Orleans. 

Vice-President — Dr. Edward Harper, New Orleans. 

Secretary — Dr. John T. Crebbin, New Orleans. 

Treasurer — Dr. R. D. Voorhies, Lafayette. 

The chair appointed Dr. E. Harper % on the committee of medical trans- 
actions, and Dr. R. Moth on the membership committee. 

It was unanimously decided to assist the Anti-Tuberculosis League 
in every way possible. 



3ptecetlanij, 



"The Modalities of Mercurius." — In the selection of a suitable 
remedy the first essential of good prescribing * is a more or less - full 
knowledge of the leading characteristic features of the drug. Ordinar- 
ily what we call modalities are of the first importance in this selec- 
tion, for the reason that they are most often characteristic of the rem- 
edy, lead more frequently to its identification, aid more completely in 
separating the pecularities of one remedy from another of the same 
class, and are seldom absent if the remedy is at all well indicated. 
Frequently it will be found that in a given case the modalities are the 
only truly characteristic points made known, characteristic in the sense 
that they are peculiar to the patient, revealing the nature of his sick- 
ness in such a manner as to identify it with him, or him with it. 

Therefore, the modalities of a remedy should be mastered first of all, 
and in the study of a remedy from the Homeopathic standpoint it is al- 
ways well to present modalities first. These mastered, memorized, 
their peculiarities comprehended, and their values understood, there 
should be comparatively little difficulty in making good prescriptions, 
especially if in addition to these we have well in hand a few distinctive 
features of the remedy. These being necessary because of similarity of 
modality in drugs otherwise dissimilar. 

Then, the first point to which I will direct your attention in the 
study of mercurius is its aggravation from heat. The mercurial pati- 
ent is almost invariably made worse from heat, heat in any form, ap- 
plied heat, dry heat, moist heat, fomentations, hot weather, etc. He 
is as sensitive to hot applications and the heat of the bed as is the apis 



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182 THE CLINIQUE. 

patient to radiating heat. I have known apis patients to go into con- 
vulsions from the mere draft of warm air from furnace pipes or steam 
radiators. Mercurius does not suffer to this extent ordinarily, never- 
theless heat aggravates him sorely at times. With the mere heat of the 
bed clothing joints will begin to ache, pains come on, the skin itches 
fearfully and he must scratch long and vigorously, the head throbs, 
and the fever rises. Hot applications, be they dry or moist, do not re- 
lieve his pains as is usually expected. Ordinarily we expect to see 
some amelioration from hot packs in painful afflictions. The hot 
water bottle or the hot fomentation is the household remedy for pains 
about joints, in a bad tooth, earache, neuralgia, and swollen glands, 
and frequently nothing suffices before the advent of the physician for 
the relief of these things save hot applications of various forms. If, 
then, we are called to such cases and find that they are not and have 
not been relieved by means of them, then we are surely called upon to 
consider the advisability of prescribing mercurius in some form. 

This aggravation from heat is not merely from hot applications. 
The heat of the bed is sufficient to start things going in a most un- 
comfortable manner. The patient may not have been cognizant of any 
trouble with his skin, so far as sensation is concerned, but just as spon 
as he gets into bed in the evening and his skin becomes warmed by the 
bed clothes first here and then there there is a crawling and itching 
necessitating counterirritation in scratching and a most uncomfortable 
state is ushered in. Only one who has had the experience can appreci- 
ate the suffering even this small amount of heat can produce under such 
circumstances. And very frequently indeed, mercurius in one or two 
doses will quiet matters and the patient roll off into refreshing sleep. 
The same is true of toothaches. The tooth does not seem to trouble at 
all until the heat of the bed warms up the body and then it begins 
and aches hard. The same is true of the periostial pains and the rheu- 
matisms. They are all worse as soon as warm in bed. The modality 
is a genuine one, verified repeatedly. 

With this aggravation from heat there is also an aggravation from 
cold. The patient is most uncomfortable indeed. He is somewhat of 
a crank in many respects. And he gets credit for being a crank. 
Most of his ailments are of the kind that tend to make folks cranky, 
and he exercises his prerogatives to the full extent. He cannot get 
warmed up to the proper temperature without becoming most un- 
comfortable, when as warm as he would like to be his sufferings are so 
aggravated that he demands a change, and when the change comes 
through throwing off the covers he gets out a few moments respite. It 



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THE CLINIQUE. 183 

is the same with the cold applications. They do but little good. He 
feels the need of them, it would seem to him that they surely would re- 
lieve, but it is only for a moment and off they must come. You have 
all seen these patients time and again. It is on again, off again, on 
again with no rest, no peace, no comfort; verily our patient is a ther- 
mometer, his symptoms rising and falling with the temperature. 
When warm in bed he becomes restless, tosses about in an effort to find 
comfort, pains come on, perspiration starts and off go the bed covers. 
And when he throws them off there comes a sense of chill, and again 
it is more pain, more nervousness, more discomfort. And thus it goes 
on from one to the other constantly. So he is worse from both heat 
and cold. And this is rather singular, is it not? And the singular 
thing in the case is a splendid point at which to figure for a successful 
prescription. 

But your mercurial case does not stop here. There are other singu- 
lar things to be considered. Many strange things come up in these 
cases, and they are very reliable if we but learn to read them aright. 
See how peculiar this is: while *he is made worse by the heat of the bed, 
he is nevertheless benefited by rest in bed. That is strange — it seems 
rather inconsistent, and so it would be if it were not that it has been so 
repeatedly verified. It is strongly confirmatory of mercurius when 
found at the bedside, and you will find it frequently, other things being 
equal. If he can only get comfortable he can lie quietly, but there's 
the rub. He has such difficulty in getting the temperature just right; 
if that can only be arranged, the bed neither too. warm nor too cold, the 
room neither too warm nor too cold, he can settle down and be quite at 
ease. How many times you have found that state at the bedside, and 
how quickly you have relieved it with mercurius. 

Closely allied to mercurius in this respect but altogether opposite is 
arsenicum, which is better from the heat of the bed but made worse 
from the rest in bed. Often we need to separate these two states; at 
times they run closely to each other, and as we are never justified in 
alternation of remedies but must closely and clearly differentiate, it is 
well to have in mind such opposite states and be prepared for the 
emergency. It is this very knowledge and the faculty of applying it at 
the bedside that makes one prescriber superior to the other. No one 
thing will do more for the young medical man to ripen him and bring 
out the promise of his skill and confirm him in the doctrines of Hahne- 
mann than this: Close attention to the similarities and opposite peculiar- 
ities of drugs. But if we have our remedies at all well in hand we will 
not find it necessary to hesitate long between mercurius and arsenicum. 



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1 84 THE CLINIQUE. 

The odor, the sweat, the characteristic foul breath, the slimy tongue 
and other general symptoms peculiar to mercurius will usually suffice 
for the distinction. But the point is well worth remembering, that 
mercurius is worse from the heat of the bed but better from rest in bed, 
but that arsenicum is worse from the rest in bed yet finds the heat 
agreeable. 

Not only is mercurius a thermometer, he is a barometer as well. 
Many times out of clear skies he is able to prognosticate the weather. 
He says we are to have a storm, he feels it in his bones, his rheumatism 
is beginning to trouble him and he knows there is to be a change in the 
weather. And this may be some days before the storm breaks. Here 
we must be prepared to consider a number of remedies. Rhododen- 
dron, rhus toxicodendron, hypericum, agaricus, lachesis, and many 
others of more or less importance; but in the majority of instances 
there will be little to cause confusion with mercurius, with the possible 
exception of rhus toxicodendron. With rhus there is the same restless- 
ness, the same ill effects from wetting, the aching and stiffness in 
bones, joints, muscles, and tendons, but the soreness is relieved by 
motion, the restlessness is not so much because he is suffering from 
the heat of the bed as it is from a desire to find a more comfortable 
position, the changing of positions is from kuowledg? that change has 
benefited, it is as many say with rhus, that if he gets limbered up or 
puts the muscles to some use he finds himself better for awhile. This 
is not at all the mercurius state. Then, again, while the tongue is 
flabby and shows the imprints of the teeth, as with mercurius, it is not 
so slimy, there is not the peculiar odor, the sweat is not oily, and alto- 
gether the remedies are not difficult to choose between. 

Just a word about hypericum. For aching, stinging, or sore corns 
and bunions worse just before a storm and during changes of weather 
there is no remedy so often indicated nor superior to hypericum. It 
does the work well, and, while it is a little thing, you will do well to 
bear it in mind. It may bring you a grateful patient some day. 

The mercurial constitution is directly and profoundly affected by 
damp weather, especially if it be damp and raw, a cold damp. This is 
especially true of the catarrhs, rheumatisms, and dysenteries. If I 
were to name the three most important remedies for affections for 
weather changes of this class I should place mercurius first, dulcamara 
second, and gelsemium third. The choice between them is difficult at 
times. Only general symptoms will suffice to enable the choice. With 
damp weather in mercurial constitutions there is swelling of the glands, 
the parotids, axillary, sublingual, and lymphatics, and not only are 



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THE CLINIQUE. 185 

these glands swollen, they become indurated, hard as stones. You 
have all seen the indurated testicle of parotitis and have experience 
with our remedy in this condition. To a large extent we find just 
such conditions frequently in other glands as the direct result of the 
cold damp. The cold damp weather rouses inflammatory conditions in 
general. With the coryza there is a general muscular soreness, a sense 
of stiffness, malaise, profuse acrid, semi-mucous discharge from the nose, 
tending to become thick greenish yellow, and with it there is a sense 
of fullness and pressure in the bones of the face and forehead, especially 
in the frontal and nasal bones; and all symptoms are worse at night, 
worse in a warm room, in the cold open air, and in damp rainy weather. 
You will find the modalities more or less constant in all cases, the 
coryza gives rise to the same uncomfortable sensations when tempera- 
ture changes are not equally adjusted. It is worse from heat, worse 
from cold, worse from anything that destroys the temperature equilib- 
rium of the patient; and this extends to all particulars; it is true of the 
muscular soreness; it is true of the nasal discharges; it is true of the 
sense of fullness and pressure alluded to; it is one of the most consist- 
ent and persistent peculiarities, and is seldom absent in a well-marked 
case. 

With the rheumatism there is a swelling of the joints. And here 
note another peculiarity of mercurius. It seems to have a peculiar 
affinity for inflammations in and about the joints of the upper extrem- 
ity rather than those of the lower extremity. You will not often find 
use for mercurius in rheumatisms of the feet and legs. When mercur- 
ius is necessary in affections of the lower extremities it is more often 
for diseases of the periosteum, especially of the tibia. In fact mercurius 
is usually our first remedy in affections of the periosteum, especially in 
such localities where the periosteum lies close to the skin, as in the 
clavicle and tibia; but in those affections ordinarily classed as rheu- 
matic mercurius covers more often the upper extremity, the fingers, the 
wrists, arms, elbows, and shoulders ; and these pains, both periosteal 
and rheumatic, are in no wise exempt from the other conditions peculiar 
to the pathogenesis of the drug. They are worse in damp weather, 
worse in warm, or rather in superheated rooms, worse at all times 
when temperature conditions are not stable and under perfect control of 
the patient. 

The dysenteries are marked; slimy, bloody stools with stinging, burn- 
ing and aching, constant tenesmus, so well described as the never-get- 
done sensation. But there are other remedies than mercurius in dys- 
entery, ipecac, nux vomica, aconite, dulcamara, aloes, bryonia, and 



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186 THE CLINIQUE. 

many others. And to single out the one for the particular case requires 
more than a mere general statement of immediate bowel symptoms. If 
we find present the terrible straining and urging, the bloody, slimy 
stool and the never-get-done state the probable remedy is mercurius. 
But it may be aloes ; it may be arsenicum ; it may be sulphur, for all 
have these symptoms in a more or less degree ; but if it is worse at 
night, worse in damp rainy weather, and the other general modalities 
of mercurius are present the selection is easier by far. Dysentery pre- 
sents at times many difficulties to the prescriber. It is a grave condi- 
tion, one demanding prompt attention. And if we know our business 
we should be able to meet it at once and control it with the first pre- 
scription at that. The case is easily spoiled and we have but little time 
for experiment. If then we find such similarity in local symptoms we 
must look to more general symptoms as guiding; aggravation at night, 
aggravation in damp cold, aggravation from warm days and cold nights y 
from sudden temperature changes; these must then, with other char- 
acteristics, lead to good selections. 

Mercurius is also aggravated by lying on the right side. It is a 
right sided remedy; pains in the region of the liver are aggravated by 
lying on the right side, ameliorated while lying on the back or left side. 
The cough is worse while lying on the right side* pains in the lower 
right chest are aggravated by pressure of mattress or pillows, but while 
lying still upon the back or left side there is little trouble. But re- 
member what was said earlier, there is an aggravation from the heat of 
the bed and it is almost impossible to remain upon the back and left 
side. The restlessness causes constant turning, so that while he is 
better on the back and left side and worse upon the right side he can- 
not help but turn over once in awhile and every time he does his pains 
are worse pr he has a fit of coughing. In inflammations in the region 
of the appendix we find this same condition. And the posture of the 
patient is sufficient at times to lead us to a consideration of mercurius 
as the probable remedy; he lies frequently upon the back with the body- 
twisted slightly to the left. When we consider this position it is rather 
striking for in most cases we find the patient upon the right side with 
the right thigh flexed strongly against the abdomen, or upon the back 
turned slightly to the right; but never make prescriptions upon posture 
alone ; that is but one symptom and used alone means nothing and cam 
aid but little in effecting cures by homeopathic means. Perhaps this 
abuse of keynotes or isolated characteristic symptoms unassociated with 
general states has done more to discourage physicians in the early 
years of their practice than any thing else. Symptoms read well in 



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THE "CLINIQUE. 187 

books but they are not always easily found at the bedside and when 
found need to be confirmed by correlative symptoms in order to lead to 
good prescribing and good cures. And many a man prostitutes his 
homeopathy by neglect ..to ascertain the peculiarities of his patient, 
being content to prescribe upon one or two symptoms of whose value 
he fails to consider in relation to other symptoms and when he fails 
blames the art and not his own stupidity. This is routinism and no 
routinist ever did nor ever can become a good prescfiber until he repents 
of his evil, turns from it and diligently applies himself in ascertaining 
the whole state of his patient and prescribes for thfc totality of symp- 
toms instead of a few isolated local symptoms. 

We have, then, as leaders in the choice of mercurius aggravation 
from heat, and applied heat, from cold and applied cold, from irregular- 
ity or change in temperature, from atmospheric changes, as from hot 
to cold, cold to warm, dry to wet, from lying on the right side, and at 
night. 

One other marked peculiarity remains, the sweat. No other remedy 
in our materia medica is so markedly peculiar in this respect. Many 
have an aggravation from sweating but none are so truly guiding as the 
sweat of mercurius, sour, offensive, clammy, oily, staining the linen 
yellow, and giving no relief to pain or fever, rather increasing them. 
These things are truly characteristic and whenever found seldom fail to 
lead to other symptoms of mercurius. But even so they cannot alone 
serve as a basis for our prescription for do we not find the same aggrava- 
tion, and to a lesser extent some of the same peculiarities in other rem- 
edies. There is arsenicum, and bryonia, causticum, chamomilla, nux 
vomica, opium, pyrogen, rhus toxidendron, stramonium, sulphur, and 
veratrum, all having aggravation from sweat. Can we then prescribe 
on the one symptom alone? The whole case must come in, the whole, 
not the particular, must be the basis for the prescription. 

And now for a few points to enable us to grasp the whole remedy. 
Aside from the modalities we have as peculiarities the following which 
are qnite reliable: 

Inflammation and induration of glands. 

Superficial, rapidly spreading ulcers, with burning, stinging pains, 
and ashy white exudates. 

Great trembling and weakness. 

Flabby, slimy, soapy tongue showing imprints of the teeth. 

Alternate heat and chill, creeping chill. 

Swollen, spongy, bleeding gums. 

Crowns of teeth decay, roots remain. 



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188 THE CLINIQUE. 

Great thirst, with moist mouth and tongue. 

Sore throat with constant desire to swallow. 

Discharges acrid, burning, stinging, thick yellow, or semi-mucous. 

Dry, fatiguing cough. 

In dysentery the corrosivus is superior to the vivus, especially if the 
tenesmus is marked. The more blood in dysentery the more perfectly 
is mercurius indicated. For closed eustachian tubes I know of no 
better remedies than nercurius dulcis in high potency, and kali muria- 
ticum in middle potency. In malignant forms of diphtheria no remedy 
can do better work than the cyanide when there is great redness, great 
difficulty in swallowing, extreme prostration, with the characteristic 
sweat, evening aggravation and putridity. 

The protoiodide with its right sided sore throat and yellow base of 
tongue will help you many times, and if it is the other side of the 
throat look to the binidoide. In catarrhal affections the vivus, in bone 
trouble and profuse suppurations the solubilis. For nose bleed, or any 
other hemorrhage with long stringy blood clot do not neglect to con- 
sider mercurius solubilis. It is one of our first remedies in gonorrhea, 
likewise in syphilis, and here it does not necessarily have to be given in 
pathogenetic doses. It is a fact that even the highest potencies cure 
syphilis. In hydrothorax no remedy is so often indicated as mercurius 
sulphuricus, especially when there is much burriing in the chest. 

But these are not the symptoms you are to prescribe on. The 
modalities are your first consideration. Without them you cannot 
make good cures. They lead, they guide, they confirm. Tie close to 
them, let them influence your thought and selection and success will 
crown your efforts and you will find less to discourage you in homeo- 
pathy. It will be your sheet anchor in times of trouble. It will help 
you in practice. It will mean better prescriptions and prescribers. It 
will mean that homeopathy is seen to be what it claims to be — a science, 
an art, the only true and sufficient, yea, all sufficient, method of heal- 
ing the sick and that nothing is superior to it when once its principles 
are grasped and applied intelligently in the confidence of positive 
possession and knowledge. 



There is one point that must always be thought of when pus has been 
aspirated after an exploratory puncture for either suspected empyema or 
liver abscess; make sure that the *«pus" does not come from a bronchus. 
This can be determined, as a rule, by microscopical examination of the 
aspirated fluid. — American Journal of Surgery. 



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THE CLINIQUE. 189 



Homeopathic Therapeutics. — By Samuel Lilienthal, M. D. Fourth 
edition. 11 54 pages. Cloth, $6.00, net. Half-Morocco, $7.00, net. 
Book expressage, extra. Philadelphia, Boericke & Tafel. 1907. 

This book appears in dignified binding, with contents which do jus- 
tice to the author and to the school of medicine which he represents. 
It is a book which will certainly prove helpful to every man who studies 
his cases and seeks* the similimum. 



The Transactions of the New York Homeopathic Medical 
Society for 1906. — This volume of 365 pages is filled with practical, 
progressive papers, which indicate the high grade of work done by our 
men in New York State. 



Manual of Clinical Chemistry, by A. E. Austin, A. B., M. D., 
Professor of Medical Chemistry and Toxicology in the Medical De- 
partment of Tufts College, Boston. D. C. Heath & Co., Publishers, 
Boston, Mass. 1907. 

There is much valuable information in the little volume of 269 pages, 
especially adapted to laboratory work for the student and practitioner. 
The author takes '"the student from the elements of the body through 
their various stages of combination, to the finished products, man." 
He offers to the physician " an interpretation of laboratory findings of 
such a character that he may learn quickly, not only that a result pre- 
sages a condition, but why it does so." 



Leaders for the Use of Sulphur with comparisons. By E. B. 
Nash, M. D., author of Leaders in Homeopathic Therapeutics, Re- 
gional Leaders and Leaders in Typhoid Fever. Cloth. 159 pages. 
$1.00; postage, 6 cents. Philadelphia. Boericke & Tafel. 1907. 

Written in Nash's usual easy and entertaining style, this little book 
rather overwhelms one with the importance sulphur plays in homeopathic 
prescribing. The author has closely differentiated the numerous reme- 
dies similar to sulphur and the book should prove valuable to one who 
has time to give to the study of the close differentiations. 



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190 THE CLINIQUE. 

Paraffin in Surgery. A critical and clinical study by Wm H. 
Luckett, M. D., Attending Surgeon, Harlem Hospital, Surgeon to the 
Mt. Sinai Hospital Dispensary of New York, and Frank I. Horne, 
M. D. Formerly Assistant Surgeon, Mt. Sinai Hospital Dispensary. 
12 mo.; 38 Illustrations; 118 Pages. Surgery Publishing Co., 92 
William Street, N. Y. City. Cloth, $2.00. 

This book covers a special field in surgery of absorbing interest both 
to the surgeon and general practitioner. The research and original 
investigations made by these authors in the use of paraffin have ex- # 
ploded many fallacies previously maintained. It presents the chemis- 
try of paraffin, the early disposition of paraffin in the tissues, physical 
state of the paraffin bearing on its dispositions, the ultimate disposition 
of paraffin, technic and armamentarium, [t thoroughly covers the use 
paraffin in cosmetic work such as saddle nose deformity, depressed 
scars, hemiatrophia facialis with a large number of photographs show- 
ing cases before and after operation, with illustrations of micro-photo- 
graphs of the disposition of the paraffin in the tissues. It also presents 
other conditions of a functional character, where paraffin can be used 
with service such as inconstinency of urine, umbilical, hernia, umbilical 
and ventral hernia, epigastric hernia, inguinal hernia, etc. The subject 
is presented in a scientific yet comprehensive manner. 

Full details are given as to the method of preparing the paraffin as 
well as the method and manner in which it should be injected. This 
book presents a wide field for the use of paraffin. It is printed upon 
heavy coated book paper and attractively bound in the best quality of 
heavy red cloth, stamped in gold. 



The tenderness in appendicitis may not be (probably usually is not) 
just at McBurney's point. The base of the appendix is, however, 
usually at, or near, that point. The site of greatest tenderness is often 
over the tip of the appendix. A line drawn between that site and Mc- 
Burney's point will many times represent the general direction in which 
the appendix is lying. — American Journal of Surgery. 



The following are some of the conditions in the presence of which an 
examination for tabes dorsalis should never be omitted: 1. All primary 
swellings of the knee or ankle joint without apparent origin. 2. " Sci- 
atica" and "lumbago." 3. A deep ulcer on tjie base of the great toe. 
4. Repeated vomiting at various intervals, with periods of well-being 
intervening. 5. Abdominal pains without other evident cause. — Ameri- 
can Journal of Surgery. 



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THE CLINIQUE. 191 

NEWS ITEMS AND PERSONALS. 

Dr. C. S. Eldridge recently received a bequest of $5000. 

Dr. L. F. Hazleton has removed from Baraboo, Wis., to Lyons, Kas. 

Dr. C. J. Swan resumed practice this week after a vacation spent in 
Florida. 

Dr. J. W. Prunne formerly of Woodstock, 111., has located in Law- 
rence, Kas. 

Dr. Ida Wendell Healey has removed from Helena, Mont., to Pull- 
man, Wash. 

Dr. O. L. Smith, Lexington, Ky., has gone to Cuba for a number of 
weeks to rest. 

Over one hundred applicants took the recent examination for interne 
in Cook County Hospital. 

Dr. Emily Shedd and Dr. Mary Leonard, Hahnemann '01 have en- 
tered into partnership in Whittier, Cal. 

Claremore, Ind. Ter., offers a good opening for a homeopathic phy- 
sician. For particulars address O. S. Webb. 

To Rent. — Office hours in the Heyworth Building, suite 1404. Ap- 
ply to Dr. T. E. Costain or Dr. C. A. Weirick. 

Swanton, Ohio, is reported as a good opening for a homeopathic phy- 
sician. It is a medium-sized town near Toledo. 

Dr. Edith S. Birney, Hahnemann '02, has left Washington to become 
the resident physician at Galen Hall, Atlantic City, N. J. 

Practice and office furniture and drugs for sale in Illinois town of 
1,200 with two physicians. For particulars address W. J. G., Clinique. 

Hahnemann Medical College is preparing a fine clinical course for 
visiting physicians who will attend the State Society meeting in May. 
Make your plans to come and take part. 

The Clinique is in receipt of a note from Dr. Frank Hill, of Rock- 
ford, saying that we have credited his paper •• The Necessity for Early 
Operation in Appendicitis " to Dr. M. B. Blouke, of Chicago. We are 
glad to apologize for our mistake and will try to not repeat. 

Dr. J. T. Crebbin, Hahnemann, \x>, now secretary of the Hahnemann 
Medical Association of Louisiana, writes that the state offers many op- 
portunities to graduates of homeopathic colleges. Our school has its 
own examining board and Dr. Crebbin will be glad to hear from any 
contemplating going to this state. 



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192 THE CLINIQUE. 

Germany has recently voted to decide who are the twelve greatest 
- men in the fatherland. The list begins with the emperor. The second 
choice is Gerhart Hauptmann, the dramatist. Robert Koch, the scien- 
tist, is third, and Ernest Haeckel and Wilhelm Roentgen, who have 
added to the scientific reputation of their country, are the fourth and 
fifth selections in the list. The sixth name is the present chancellor of 
the empire, Prince von Buelow, seventh and eighth are Max Klinger, 
the painter and sculptor, and Richard Strauss, who has been selected to 
represent music. August Bebel, the socialist, and Count Haeseler, 
who is high in the military affairs of the country, are ninth and tenth. 
The eleventh niche was awarded to Ernest von Behring, the physician 
and scientist, and Reinhold Begas, the sculptor, completes the list. 
— Medical Counsellor. 

Pennsylvania raises the 'requirements for admission to medical school. 
According to the plan finally adopted, the requirements will be in- 
creased gradually beginning with the annual session in September, 1908, 
and reach the maximum September, 1910. The present requirements 
cover four years graded course in a High School or its equivalent. The 
essential points in the new requirements are as follows: 

I. For the session 1908- 1909, in addition to the present requirements, 
either one of two foreign languages, French or German; (2) Physics; 
(3) Inorganic Chemistry, including qualitative analysis; (4) General 
Biology or General Zoology. 

II. For the session 1909- 1910, in addition to the requirements of 1907- 
1908, the candidate must have completed successfully work equivalent 
to that prescribed for the Freshman Class in C<)lleges recognized by 
this University. 

HI. For the session 1910-1911, in addition to the requirements of 
1907-1908, candidates must have completed successfully work equiva- 
lent to that prescribed for the Freshman and Sophomore Classes. 

IV. Candidates who have successfully completed at least three years 
of an accepted College Course, may be admitted with conditions in 
Chemistry, Physics and General Biology or Zoology. 

The maximum requirement is two years of collegiate training, includ- 
ing Biology, Chemistry and Physics. The two additional years of Col- 
legiate training are regarded as an adequate preparation for entrance 
into a professional school. The importance of the candidate having had 
instruction in subjects leading to the study of Medicine is so generally 
recognized that Biology, Chemistry and Physics have been added to the 
requirements. This combination of special and general training is with- 
out doubt a much more logical requirement than a Collegiate degree 
which does not imply any special preparation for medical studies. 



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THE CLINIQUE. 

VOL. XXVIII. APRIL, 1907. NO. 4 



(IfhiQmal Articles. 



INFANT FEEDING. 

JOSEPH PETTEE COBB, M. D., CHICAGO. 

The subject of infant feeding has only in the last few years been re- 
ceiving something like the attention which it merits. There is a pretty 
wide-spread acceptance of the principles which pediatricians have for 
years been contending for; viz: 

First. Infants, when possible, should be nursed by their mothers; 
the valid objections to this rule are more limited than has been the 
practice in our cities; the acceptable reasons for weaning do not include 
any condition either domestic, social or pathological which can be cor- 
rected or any habit which depends upon anyone's ease, comfort or in- 
dulgence. 

Second. Outside of a few disease conditions of the mother, not of a 
temporary character, an imperfect food supply by the maternal breast 
is the only valid reason for weaning. The food supply may be imper- 
fect in several ways: viz., it may be insufficient in amount; it maybe 
insufficient in quality in that it falls; so far below the normal standard 
that it does not afford sufficient nourishment for the child. The abso- 
lute food value of the milk may be high yet the relative proportion of 
the ingredients may render it difficult of digestion for the individual 
baby. In all of these particulars important changes may often be ac- 
complished by intelligent advice to the mother accompanied by consci- 
entious cooperation on her part. It has been altogether too common a 
habit to discontinue nursing and to recommend off-hand some manu- 
facturer's food at the first sign of trouble; it requires more time and 
study and knowledge to modify the mother's habits and to educate the 
baby's digestive organs, yet both of these objects can often be obtained. 
The extra trouble of the first weeks is well spent when the desired re- 
sult is obtained. 



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i 9 4 THE CLINIQUE. 

Third. Pediatricians contend that only by repeated chemical exam- 
inations of the milk can any physician obtain the absolute knowledge 
which warrants him in presuming to advise the mother about her own 
habits as they bear upon the milk supply and concerning the desirabil- 
ity of continuing or discontinuing the nursing of her infant. Nothing 
can be intelligently accomplished in dealing with the propositions con- 
tained under our second heading in the absence of that knowledge which 
comes from the repeated examinations of the milk. I am aware that 
inferences may be drawn from observation of the milk, the baby's stools 
and the baby's behavior; these observations may be shrewd, and, from 
long experience, sometimes lead to wise conclusions, but, in spite of 
long experience, they are often, very often, misleading; they are always 
open to doubt. 

Fourth. Mixed feeding, as a general proposition, is more desirable 
than complete weaning and a dependence solely upon artificially pre- 
pared foods. Conditions warranting early mixed feeding are an insuf- 
ficient amount of breast milk; our inability to bring the percentage of 
fat up to a permissible minimum; our inability to reduce the percent- 
age of proteid to a digestible maximum; and our inability to prevent 
the mammary gland from acting as an excretory organ (this last condi- 
tion, if persistent, will demand weaning). In mixed feeding there is 
a wide choice wherein to find the most desirable complement to the 
mother's milk. If the milk is simply insufficient in amount, is a fairly 
good production, with the ingredients present in relatively proper pro- 
portions, we should offer a food for the substitute feedings approximat- 
ing as closely as possible the formula of the mother's milk. 

If the percentage of fat is too high (which is rarely the case) it is 
wise to offer a substitute feeding once or twice daily of a low fat value 
with the proteid at the upper relative proportion. 

If the percentage of fat is low and that of proteid high (a common 
fault) it is usually wise to make the substitute feeding of normal fat 
value and take out all the casein leaving of the proteids only the lact- 
albumen. 

In other words if the milk is good, imitate nature; if the milk is de- 
ficient in some particular, supplement nature's product. 

The substitute feedings, whether one, two or more daily, should 
come at a certain definite time each day; a proper interval of time 
should intervene between the feeding, the prior and the subsequent 
nursing; if more than one feeding daily is required, the feedings should 
divide the day as evenly as possible. 

Fifth. We have no right to overlook the baby's future welfare be- 



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THE CIJNIQUE. 195 

cause we are dealing with his present necessities. Because a food is 
easy of digestion it does not necessarily follow that it is nutritious, that 
it is supplying all the needs of the growing organism. It is a well 
known fact that condensed milk babies are plump and for several 
months are free from digestive disturbances. It should be as well 
known that in spite of their fat they are not well nourished and that 
their reserve vitality is low ; consequently they make a poor opposition 
to any infection which gains an entrance into their system. There 
are manufactured foods on the .market whose relative variation from the 
standard of mother's milk is just as marked as that of condensed milk, 
and consequently the infant fed solely upon them will suffer in. a simi- 
lar way. 

The unfortunate part about these patients is that they seem to be 
doing exceptionally well; the parents are banking upon a condition 
that does not exist. The physician has not learned that malt sugar 
and starch derivatives, for instance, are unsatisfactory substitutes for 
cream. 

It is a safe proposition that no manufactured food should be regularly 
used for feeding any infant until the physician has compared the actual 
formula of the food when prepared for feeding with the formula of 
mother's milk, and has made an intelligent effort to make the prepared 
food approximate chemically the standard of mother's milk. 

It is equally as safe a proposition to make to state that no food mix- 
ture can be a satisfactory food that does not contain fresh milk. When 
I say satisfactory I mean that it must satisfy the varied demands of a 
growing organism and not simply be easy of digestion. 

My sixth principle is that fresh cow's milk modified to approximate 
the standard of average mother's milk is the best artificial food for the 
average normal healthy child; that the possibilities of variation of the 
different ingredients to suit the demands of different children is more 
easily made in an intelligent modification of cow's milk than in the 
use of any other food. 

I recognize the fact that many babies, do not thrive upon modified 
cow's milk, but in the majority of instances it is my belief that the 
fault is not with the milk, and not necessarily with the party who makes 
the modification but more frequently with the physician who gives the 
direction. From my own observation, I have learned that but com- 
paratively few physicians really give accurate directions for the modifi- 
cation of the milk but inform the laboratory, when a laboratory is made 
use of , to send the prepared milk for such a baby; or, if instructions 
are given to the mother she is told to use a materna glass, without any 



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196 THE CLINIQUE. 

specific instruction and without careful consideration of the baby's re- 
quirements. 

I have known an instruction to be given in much the following way: 
viz., that good cow's milk should be diluted with a third of its bulk of 
lime water and cream added. 

It is not surprising that babies do not thrive upon milk modified with 
as careless instructions as the above. 

Again, I appreciate the fact that milk laboratories from time to time go 
astray, either through carelessness of the men within the laboratory, of 
individuals who handle the milk before it reaches the laboratory, or 
even with the delivery wagon after it has left the laboratory. 

Recognizing all these points, most of which are avoidable, with other 
pediatricians I still contend there is no prepared food to take the place 
of fresh milk properly modified for the individual baby. 



REMOVAL OF A PIECE OF IRON FROM AN EYE FOLLOWED 
LATER BY GONORRHEAL IRITIS. 

EDGAR J. GEORGE, M. D., CHICAGO, ILL. 

On the afternoon of September 30th, 1904, I received a telephone 
message from a physician, residing in a town 40 miles from Chicago, 
requesting me to remain in my office until 6:30 o'clock to see a 
young man, who had just gotten a piece of steel in his eye and would 
arrive by train. At the appointed time the patient came accompanied 
by his mother, both in an intense state of excitement. 

The patient, 20 years of age, was employed in iron bridge construc- 
tion work for a railroad. That afternoon while holding a rivet as it 
was being riveted by another workman, a piece of metal was cast off 
from the hammer and struck him in the right eye, causing immediate 
loss of vision. On examination a horizontal perforation through the 
cornea about three millimeters long near the periphery, at the upper 
border of the inferior nasal quadrant was distinctly visible, accompanied 
by a tear in the iris; the anterior chamber was shallow, the pupil con- 
tracted and the iris pushed forward toward the cornea. The tension of 
the eyeball was markedly diminished from loss of aqueous humor through 
the penetrating wound of the cornea. Carefully passing a sterile probe 
through the corneal wound and iris, following an opening into the vit- 
reous chamber, demonstrated conclusively that the metal was within 



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THE CLINIQUE. 197 

the eye. An ophthalmoscopic examination was impossible on ac- 
count of the contracted pupil and the shallowness of the anterior 
chamber, and was of little consequence as the diagnosis was positive, 
therefore I proceeded at once to attempt the extraction of the metal 
with the magnet. 

Under cocaine anesthesia, using a cataract knife, the corneal wound 
was enlarged and the incision extended down through the periphery of 
the lens, in order that a fair sized point of a Carliczek magnet could be 
inserted and the particle have a free exit. A suitable point was selected 
and attached to the magnet, then inserted into the wound and the cur- 
rent applied. Immediately a metallic click was heard as the metal be- 
came attached to the magnet. On attempting to draw it through the 
wound it was found difficult on account of the broad surface of the 
foreign body and it required several attempts before it was brought out 
edgewise. 

Under the instillation of atropine to keep the iris and ciliary muscle 
at rest, with cold applications and rhus tox. 3 x internally, all inflam- 
mation subsided without any further trouble or complications, although 
a traumatic cataract followed. 

On July 26th, 1905, ten months after the injury, I again received a 
telephone message from the physician stating that the young man's 
left eye was inflamed, and that he was afraid that it was sympathetic 
ophthalmia and that he was again on his way to see me. 

On his arrival the young man informed me that both eyes had been 
slightly inflamed for about a week, though they had not given him any 
particular trouble until three days before when the left eye became 
more inflamed, the vision dim, with some pain in the supraorbital 
region. On examination I found a slight ciliary injection of the right 
eye (formerly injured) but the left was markedly inflamed, the pupil 
sluggish to light and there was loss of the normal lustre of the iris. 
The eye was not particularly sensitive to touch, and photophobia and 
lachrymation were only moderate. However, the case looked suspi- 
cious. 

Taking the conditions into consideration I did not think that the in- 
flammatory symptoms seemed profound enough to warrant a diagnosis 
of sympathetic ophthalmia, the eye lacked the sensitiveness on palpa- 
tion and the degree of photophobia and lachrymation that are usually 
present. As to the injured eye, I was certain that neither the steel nor 
my manipulation in extracting had wounded the ciliary body, and I 
felt confident that there was before me a case of simple iritis. 

In looking, for a cause I made inquiry as to whether he had contracted 



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198 THE CLINIQUE. 

syphilis or was subject to rheumatism. Syphilis he denied, rheuma- 
tism he complained of in his left ankle. I prescribed the usual treatment 
for iritis, namely: instillation of atropine, the application of dry heat, 
and mere. sol. 3 x every hour. The next day the condition was the 
same, except a fair dilatation of the pupils was obtained. A few days 
later he confessed that he had had gonorrhea for several weeks, which 
substantiated my diagnosis. He made a good recovery. 

Iritis coming on during the early stages of gonorrhea is very rare 
and is not associated with any changes in the joints or fasciae, nor is it 
subject to relapses while that of the chronic form is generally met in 
the gleety stage preceded by (or associated with) articular swelling 
and pain. Sometimes painful affections of the peripheral nerves, as 
sciatica, take the place of the joint involvement. This form is chronic 
and there is a tendency to relapses, both iritic and generally rheumatic; 
the latter conditions may be associated or alternate, the pain leaving 
the joint when the eye or eyes become inflamed. 



LOCAL ANESTHESIA IN NOSE AND THROAT SURGERY. 

RICHARD H. STREET, M. D., CHICAGO. 

The subject of local anesthesia in the practice of our specialty is one 
of increasing importance, since with the improvement in our technique 
it in many instances has taken the place of general anesthesia. This 
is of great advantage to both operator and patient, making compara- 
tively easy many delicate operations in the nose which would be almost 
impossible with the patient under a general anesthetic. It lessens the 
danger to the patient and minimizes the discomfort. 

Many drugs and combinations of drugs have been employed as local 
anesthetics. It is unnecessary to be familiar with all of them, but a 
knowledge of several of the more important is essential. 

The most valuable of all drugs for local anesthesia is the hydrochlo- 
rate of cocain, and it is the most reliable in the majority of cases. 
However, there are conditions in which it is contraindicated, and then 
we should think of such drugs as betaeucain, holocain, Schleich's solu- 
tion, novocain and nirvanin. 

Beta eucain has less effect upon the heart but otherwise its action is 
the same as cocain and it may be used in stronger solutions with safety. 



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THE CLINIQUE. 199 

The anesthesia of holocain is of short duration and not profound but it 
is claimed to be entirely harmless. Schleich's solution produces an- 
esthesia when injected into the tissues, with a much smaller amount of 
cocain than when that drug is used alone. Novocain is one of the 
synthetic preparations made to take the place of cocain and is used in 
the same manner in from 1% to 10 % solution. It acts well with the 
suprarenal preparations and is claimed to increase their efficacy. It 
has no depressing effect upon the heart. The claim made for nirvanin 
is that it produces no constitutional effect whatever, but it is somewhat 
. uncertain in its action and in consequence has not come into very gen- 
eral use. 

Before taking up the methods of applying anesthetics for operative 
purposes I wish to mention a drug which is of great value in preparing 
a sensitive throat for examination, bromide of soda, or bromid of potash 
in 3 % to 10 % solution used as a gargle and held in the mouth for a few 
minutes will control the most irritable throat so that an examination of 
the larynx and pharynx can be made with ease. 

As there is so little difference in the methods of administering the 
above mentioned drugs we will devote our time to a brief description of 
the technique of cocain anesthesia in the nose and throat. 

Nose. — The best method of anesthetising for operations within the 
nose is to first cleanse the cavity with a mild alkaline solution then in- 
troduce one of the suprarenal preparations in the following manner: 
Roll a pencil of cotton on a spiral applicator which releases it with a re- 
verse twist. The first pledget is to be placed upon the floor of the 
cavity. The others are to be gently laid one on top of the other until 
the space is completely filled. These are allowed to remain from three 
to five minutes. With their removal the field is ready for the introduc- 
tion of the anesthetic proper. The suprarenal has lessed the tendency 
to hemorrhage and restricted the area of cocainization, also prevented in 
part its entrance into the general circulation. Now introduce a pledget 
of dry cotton with the Noyes alligator forcep into the posterior part of 
the cavity beyond the field of operation. This is to prevent the drip- 
ping of fluid into the nasopharynx. A 10 % cocain solution is now ap- 
plied in the same manner as the suprarenal and is left in place for from 
ten to fifteen minutes which is quite long enough for complete anesthe- 
sia though some operators devote half an hour to this procedure. 

Pharynx. — For operations upon the faucial and lingual tonsils I con- 
fine myself to the injection method, which I have found far superior to 
others, such as rubbing with cocain powdered or in solution, or introduc- 
ing it upon small pledgets of cotton into the crypts of the tonsils. For 



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200 THE CLINIQUE. 

this purpose I employ an instrument which is simply an Anel's lachry- 
mal syringe to which is attached a canula, nine centimeters in length, 
straight for the faucial tonsil and curved for the lingual. The needle 
is the smallest sized hypodermic (No. 28 used in dental surgery) very 
short and especially sharp. The ordinary hypodermic needle is unsuit- 
able on account of its large size causing pain and hemorrhage, and its 
length making it a dangerous instrument for use in the throat. The so- 
lution used is two parts of a 2 % cocain solution to one part of adrena- 
lin chloride 1 to 1,000 or suprarenal in solution 1-1000. The supra- 
renal lessens the hemorrhage and here also restricts the amount of co- 
cain taken into the general circulation. 

In anesthetizing the faucial tonsil for its removal the injection should 
be made deep into the substance of the tonsil and through the anterior 
pillar using about four cubic centimeters of the solution for each tonsil 
or until the tonsilar tissue shows a paleness which indicates a suffi- 
cient degree of anesthesia. It si advisable to wait until the hemorrhage 
is cofnpletely controlled after removal of the first tonsil before proceding 
with the injection of the second. 

When the lingual tonsil is to be operated upon attach the needle to 
the curved canula. Instruct the patient to pull the tongue well out 
and down, and with a laryngeal mirror to guide you inject into the tissue 
to be operated upon. 

I have found that with this method of anesthetizing the removal of 
tonsils is a practically painless procedure. The patient having better 
control of the throat the operation is more quickly and accurately per- 
formed. 



UTERINE DISPLACEMENTS. 

ELIZABETH C. MAAS, M. D., ROCKFORD, ILL. 

There are few disorders of the female genital organs that are produc- 
tive of more distress and suffering and more worthy of the careful at- 
tention of the physician than that of uterine displacements. 

The normal position of the uterus cannot be indicated by definite 
lines of specific limitations. By the nature of its construction and in 
consequence of its visceral relations, it has a considerable range of 
mobility, normally the uterus leans forward to such a degree that its 
long axis lies at right angles with the brim of the pelvis, its fundus lies 
a little below a line drawn from the upper border of the symphisis pubis 



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THE CLINIQUE. 201 

to the promontory of the sacrum. While this defining of the position 
is as nearly correct as can be stated, the fact should be remembered that 
this organ vascillates both in actual location and relative position. 
Situated between organs subject to distension and collapse, the uterus 
may be forced forward by a loaded rectum or sigmoid, while in the 
presence of an empty bowel and a distended bladder, the fundus is 
lifted upward and backward. Its lateral mobility, while not so great, is 
yet marked and rotary motion is in some degree possible. Aside from 
these movements the uterus has to a certain extent an up and down 
movement, rythmical with the respiratory movements of the abdomino- 
thoracic diaphragm. These movements are normal, and any change 
of position within this normal range of activity should not be con- 
strued as a departure from the healthy standard. With the rectum 
and bladder empty and no undue pressure from above, the uterus will 
be found to return to a position approximately that already defined. 
The positions assumed may be regarded as anomalous, but so long as 
the uterus is able to return spontaneously to its normal position after 
the transient cause of its deviation has ceased to operate, it cannot be 
charged with displacement. It may be said to be displaced only when 
it persistently remains in a position distinctly at variance with the one 
which it should occupy under average conditions. There must be 
limitations of automatic movement, prolonged departure from the 
normal position, and inability to maintain that position when regained. 

The retro-deviation is probably the most common variety. This 
may be produced primarily by any cause which may induce abnormal 
intra-abdominal pressure. Lifting a heavy object, violent vomiting, 
prolonged coughing, a blow or fall. But, while incidents of this char- 
acter may serve as direct cause, there is in the majority of instances a 
predisposing cause or condition of the system that must be regarded as 
part of the problem. Incidents capable of serving as the cause direct 
are of daily occurrence in the life of every woman, but it is only in cases 
of enfeebled vitality that they prove effective. It is only in cases of 
malnutrition and enfeeblement that elasticity of the abdominal and pel- 
vic muscles are impaired, that power to regain the erect is wanting. 

It is claimed by most gynecologists that the predisposing causes in 
the majority of cases are chargeable to puerperal experiences; inasmuch 
as most victims of this misfortune are found among those who have 
borne children. In many of these cases we will find the pelvic weak- 
ness and liability to displacement was there before the pregnancy and 
the deviation was established at this time because the uterine attach- 
ments and abdominal muscles were relaxed. Malpositions of the uterus 



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202 THE CLINIQUE. 

are very common among young women whose employment requires 
long hours of standing, and in school girls much and improper stair- 
climbing will cause it. 

This abnormal condition by no means always requires treatment, in 
many cases no symptoms whatever arise from it. Where the deviation 
follows the puerperal condition and we have a large, heavy subinvoluted 
organ with both cervical and perineal lacerations, surgical treatment is 
indicated, but this alone will not be sufficient in the majority of cases, 
this must be followed by a general tonic treatment, electricity, massage, 
etc. When due to a general relaxed condition of the abdominal walls 
and pelvic structures, operative procedure is of no value, the tonic 
treatment and supporting the organ with a properly fitting pessary 
until the parts have regained tone, will in most cases bring about the 
desired results. If in some instances after this treatment, there is still 
a disposition to assume the abnominal position, the patient is in good 
condition to have a ventral suspension done and to derive the full 
benefit from it. 



SARCOMA OF BONE.* 

W. B. ROBERTS, M. D., MINNEAPOLIS, MINN. 

Sarcoma of bone occurs infrequently as compared with sarcoma in 
other tissues. It may be a secondary growth, but is almost always pri- 
mary. It may be found in any bone, but its more frequent sites are 
the jaw, the femur, the tibia, the humerus, in the order named. Like 
sarcoma in other regions, the bone sarcoma utilizes more or less of the 
connective tissue of the osseous type for a framework. Like sarcoma 
in other situations there is a variance in the malignancy of different in- 
dividual tumors. Sarcoma is generally spoken of as a tumor of youth, 
in contradistinction to carcinoma, which is known as the tumor of age. 
Sarcoma occurs more often in early life, most commonly between the 
ages of 20 and 30. Cases are, however, recorded between the ages of 
2 months and 71 years. Some writers claim to have seen children 
born with demonstrable bone sarcoma. The more malignant forms are 
seen most often in youth. Traumatism appears to play an important 
part in the history of sarcoma of bone. Usually it is in the nature of 
a bruise or twist rather than a fracture, although sarcoma is seen devel- 
oping in the callus after fracture, especially when there has been non- 
* Read before the Minnesota Homeopathic Institute, 1906. 



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THE CLimQUE. 203 

union. The tumor may not appear for some time, — even years, after 
the trauma, but is usually a history of a tender point which persists. 

Pain is practically a constant symptom. It is more severe than in 
tuberculosis and more localized. It is not usually related to the joint 
and is not accompanied by joint symptoms. The tumor usually ap- 
pears (if in a long bone) at the end, on the diaphyseal side of the epi- 
physis. Pathological fracture sometimes occurs early and in the course 
of the disease develops more often than in tuberculosis or osteomyelitis. 
There is no fever, no inflammation and no sequestrum. 

Osteomyelitis, tuberculosis, and syphilis are the conditions which 
come to mind when diagnosing bone sarcoma. Osteomyelitis is accom- 
panied by fever or history of fever of a pyemic type; inflammation, pain 
along the whole bone and generally relieved by firm pressure; leucocy- 
tosis; swelling on the distal side of the epiphysis; edema of tissues or pus; 
sinuses; sequestrum or involucrum as the disease progresses. Tuber- 
culosis has fever of hectic type; joint symptoms (as tenderness and re- 
striction of motion); swelling beginning at the epiphyseal line; sinuses 
lined with pale, watery, edematous granulations and in which the bacil- 
lus may be found; baring of bone; the formation of certain worm-eaten 
sequestra. Syphilis usually has a suggestive history; symmetrical 
swelling of the shaft of the bone; no fever; no special tenderness; no 
edema; pain of a peculiar nocturnal type. The clinical diagnosis of 
sarcoma can be made in the majority of cases. X-ray examination and 
exploratory incision clear up many clinically doubtful cases. As a last 
resort for diagnosis we have the microscope. 

Sarcomata of bone fall naturally into two classes — the periosteal 
form occurring between the periosteum and the bone — and the medul- 
lary occurring in the cavity of the bone. In each location there are a 
a number of varieties, classified according to their histological char- 
acters. 

Periosteal osteo-sarcoma occurs clinically as a hard, irregular, bony 
growth — asymetrical — and differing from exostosis in its more rapid 
growth, larger size, and infiltration of muscles. Upon section we see 
between periosteum and bone a firm pink or red mass which contains 
spicules of more or less completely formed bone arranged perpendicular 
to the shaft and surround by soft tumor tissue. X-ray examination 
shows the shadow of the bone and the tumor springing from the sur- 
face — the bony spicules giving dark shadows and the soft tumor mass 
lighter shadows. The medullary cavity is not attacked and shows 
normal with a light smooth shadow. Histological examination shows 
bony tissue, in a state of more or less perfect development; spindle 
cells; and round cells — the former predominating. 



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20 4 THE CLINIQUE. 

The history of such tumors is that they grow slowly; do not give 
metastases; attack bone seldom. They are therefore comparatively 
benign in character. 

Periosteal giant-cell sarcoma corresponds to epulis of the jaw, a cir- 
cumscribed growth on the shaft of bone — rather soft and boggy. It 
may pulsate. It is of slow growth. X-ray shows a mass springing 
from the shaft and giving a peculiar shadow, rather light and marked 
off into illy defined lobules by fine dark lines. These lines appear to be 
caused by irregular absorption of the bone and by variation in the den- 
sity of the tumor. The appearance is characteristic of giant cell sar- 
coma only. On section between periosteum and shaft, a mass of tissue 
looking like granulation soft, friable, and red (almost maroon) in color. 
The microscope reveals large numbers of giant cells and spindle and 
round cells in lesser numbers. These tumors have quite a benign his- 
tory and do not recur after complete removal. Periosteal spindle and 
round cdl sarcoma grows rapidly. It presents no absolutely differen- 
tial clinical signs. It is less firm than osteosarcoma and sometimes 
quite soft. It does not pulsate. X-ray shows alight shadow of tumor 
mass which tends to penetrate the shaft. This shadow is not lobulated 
nor marked by shadows of bony spicules. Upon section we see a white 
mass in the space between periosteum and bone. It may be pearly 
white, soft, and non-friable or dull white, dense, and granular. It may 
penetrate the bone and infiltrate the muscles. Microscopical examina- 
tion shows many spindle and round cells held together by a small 
amount of connective tissues. It is a very malignant growth, rapidly 
destroying the tissues and causing metastases. Its malignancy in- 
creases with the preponderance of round cells. 

Periosteal perithelial angiosarcoma is a rapidly growing tumor which 
in a remarkably short time attains large size. It is soft. There is uni- 
form swelling over the affected area. It rapidly attacks the soft 
tissue and in places shows discolorations of the skin, resembling bruises, 
and caused by subcutaneous hemorrhages. There is no pulsation. 
X-ray gives us an indefinite shadow of a large growth invading bone and 
muscle. On cutting into it we find a very vascular growth containing 
numerous large venous vessels in a loose connective tissue stroma. 
There are many blood clots and areas of necrotic tissue. There may be 
a partial capsule. In the loose meshes of the growth there are areas of 
firm, cellular, whitish material extending into bone and muscle. His- 
tological examination shows the dense areas to consist of round and 
spindle cells in masses. All through the growth are seen cells closely 
surrounding the venous channels and forming their walls. This is 



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THE CLINIQUE. 205 

the characteristic arrangement. These cases have been uniformly fatal 
from the great destruction of tissue and the early and numerous metas- 
tases. 

The medullary bone sarcomata histologically fall into classes sim- 
ilar to the periosteal. Medullary myxo-chondro-sarcoma corresponds 
to the periosteal osteo-sarcoma. It is the least malignant of the medul- 
lary types. It grows slowly. By pressure the shaft of the bone atro- 
phies, and we have eventually an expanded shell of bone, which is at 
times so thin as to crackle under the fingers. Over this expanded sur- 
face we find hard and soft areas alternating. X-ray shows an enlarged 
medullary cavity surrounded by a thin shell of bone. The shadow of 
the growth is somewhat lighter than the bone and is mottled. On cut- 
ting into the shell, the medullary cavity is found occupied by a mass 
which looks and feels much like gristle. It is hard and cellular in spots; 
softer and more watery in others. There are usually some cysts con- 
taining clear or bloody serum. Histological examination shows areas 
of cartilaginous material and cysts in a loose connective tissue mesh- 
work. 

These tumors have a quite benign history in that they are of slow 
growth; do not give metastasis early; and do not cause rapid destruc- 
tion of the soft tissues. 

Medullary giant cell sarcoma has a history of dull pain and slow expan- 
sion of bone over a limited area. The surface of the bone is usually 
rougher than normal. There is sometimes pulsation, from which fact 
the tumdr has been called bone aneurism. (Cutting off the main blood 
supply has often checked these growths for a long* period of time). 
X-ray picture is of the character before described for giant cell sarcoma. 
We see within the enlarged medulla the lighter shadow of the tumor 
mass, marked off into lobules by fine darker lines. Usually there is to 
be found some new bone under the periosteum thrown out from irrita- 
tion and which shows as an irregular thickening of the shell. Upon 
section tissue similar to that described in periosteal giant cell sarcoma is 
found. The mass can be quite easily shelled out of the cavity and sep- 
arates easily from the normal medullary tissue. The cavity is not quite 
smooth, but is marked by small depressions and lines, containing parti- 
cles of tumor tissue and the open ends of the many vessels which spring 
from the bone to supply the growth. Under the microscope many giant 
cells are found. This tumor has quite a mild history. Some cases have 
been held in abeyance for a long time after ligation of the principal ar- 
tery supplying the part. . They do not tend to give early metastasis. 
They do not recur after removal. 



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206 THE CLINIQUE. 

Medullary spindle and round cell sarcoma too present similar clinical 
signs as to a long period of pain following the reception of an injury. 
They do not tend to expand the bone, but rather to penetrate it, and 
cause pathological fracture. The gross pathology, X-ray appearance, 
and histological make-up are similar to their periosteal prototypes. 
Like the periosteal growths they tend to rapidly grow at the expense of 
bone and muscle; to cause early metastases, pathological fracture, and 
have a bad prognosis as to length of life after their growth begins. 

Medullary perithelial angio-sarcoma resembles in all ways the same 
growth in the periosteal type. It is a little more rapid in its growth in 
this region and traverses the entire bone in a few weeks' time. It is 
terribly malignant and causes death always. No cases of demonstrated 
perithelial angio-sarcoma have been reported as recovered. New bone 
is seldom produced in any of the medullary types of sarcoma except 
upon the shaft and as a result of the irritation of the growth. 

Bone sarcoma is a surgical condition. It may be that in the near 
future there may be found some antitoxin that will effectually combat 
the disease. At present our only recourse is the knife. And that this 
may be of any benefit it must be applied early. Early incision for the 
purpose of diagnosis I believe to be an important and justifiable meas- 
ure in any case in which the diagnosis cannot be made through other 
means. In the less malignant forms this procedure has not apparently 
increased the dangers of metastasis nor stimulated the growth to more 
rapid advance. And in the malignant cases the naked eye appearance 
upon section is such as to immediately suggest a sweeping operation in 
some types or the futility of operation in others. Study of the histories 
of these tumors teaches us that those growths in which we can demon- 
strate the most bone or the most giant cells are of the least malignancy 
— least destructive and least liable to give metastases. Therefore in 
these cases conservative operation consisting in the complete removal 
of the tumor can be made with a fair prospect of cure even though the 
case be not diagnosed in the very early stages. Other forms of bone 
sarcoma have proved to be very malignant and death from internal 
metastasis usually occurs within a year after the tumor is apparent. 
If the round and spindle celled tumors are operated very early and with 
a liberal allowance of apparently good tissue to take care of wandering 
and isolated tumor cells, some cases have not recurred. No cases of 
perithelial angiosarcoma have been saved although some have been 
subjected to sweeping operation within 90 days after the first apparent 
signs of the tumor. 



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THE CLINIQUE. 207 

PAIN. 

KATHERINE E. JAMES, M. D., ROCKFORD, 11,1,. 

Lord Edward Lytton has placed in the mouth of his creation Lucile 
— "There is a purpose in pain otherwise it were devilish." He spoke 
purely from a sense of moral development — but I prefer to take it as 
my test for a physical demonstration. 

Women will endure the uncleanliness and excoriations of a disgust- 
ing leucorrheal discharge without other than a murmur of complaint, 
but just as soon as she experiences pain of any charcter in the pelvis, 
she entertains fears of cancer or tumor and there passes through her 
mind visions of the surgeon's knife, the hospital with all its attending 
fears — and then to find ease or know the worst — she consults her 
physician. 

To know the true value of pain we must know the anatomical rela- 
tion of the pelvic organs. Bounding this region above by a line drawn 
from the crests of the ilia, and below from the lowest border of the 
tuberosities of the ischi, we have that portion of the body which we 
designate as false and true pelvis, containing a portion of the small in- 
testines, the rectum and sigmoid, the uterus with its appendages — a 
portion of the ureters, the bladder, the prostate gland, the vagina and 
the external organs of generation, the nerves, blood vessels and lym- 
phatics belonging to this region — muscles, fasciae and peritoneum 
which lines this wonderful casket. 

Pain is designated by different terms. A patient describes a pain as 
throbbing. We are immediately reminded of an inflammation probably 
going on to a pus formation. • A pain described as lancinating — especi- 
ally after stool — we immediately see a fissure. A griping pain behind 
the pubes or along the line of the ureters recalls polypus, enlarged 
prostate — cancer or stone in the bladder. A radiating pain above the 
pubes will make us think of a distended bladder or an inflammation of 
the bladder. A sickening pain in the epigastrium, a pregnant uterus, 
or in the inguinal region — a hernia. Pain described as heaviness 
and weight in the back may mean a backward displacement, 
may mean an impacted bowel. A hot pain in the top of the 
head, subinvolution. A tenesmic pain after urinating may mean 
cystitis or a urethral caruncle. Metritis, endometritis, inflamma- 
tion of the ovaries and tubes, displacements, pelvic peritonitis, celluli- 
tis, polypi of the uterus, urethral caruncle, fibromata, cancer, subinvolu- 



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208 THE CLINIQUE. 

tion, appendicitis, neuralgia, extrauterine pregnancy, adhesions — all 
have a prominent — we may well say the first mentioned symptom — 
pain. So one can go on enumerating pains with their descriptive ad- 
jectives in all the locations as our patient cite them to us — and still we 
say " adhesions " — " pus n — " tumor " and know neither the organ nor 
the location. So we go on emphasizing that prominent symptom — but, 
in so doing, do we often lose sight of the associating ones and thus err 
in our diagnosis. 

I recall four cases. Young women — three of them employed cler- 
ically, which means hours of standing and long walks to and from 
places of employment in all kinds of weather. In each of these cases 
pain was a prominent symptom. Pain and sensitiveness in the right 
iliac region. Constipation and indigestion were the accompanying 
symptoms. Surely with such a history one is safe in making a diagno- 
sis of appendicitis. It was made and operations performed. Recovery 
was uneventful — but the pain persisted. In an interval varying from 
a year to eighteen months after the operations these women came to me. 
In one I found a backward displacement with a displaced right ovary. 

In the other two, ovarian congestion. The fourth case was unusual 
and interesting. I was called because of a persisting pain about six 
weeks after the patient had had an appendectomy — I found a mass of 
adhesions encasing a greatly diseased right ovary and a pus tube. We 
have all cured pain in the stomach by repositing a retro-displaced uterus. 
Many a headache unrelieved by local electricity, glasses, and remedies, 
has yielded to depleting and faradic electricity and the positive pole 
of the galvanic current. Pains and cramps in the legs have been cured 
by removing pressure above. Pain in the left ovarian region at the 
menses has been relieved by thoroughly evacuating the bowel just be- 
fore the period. We have all grown grey in the effort to relieve a pain, 
supposedly a cystitis, which on examination we found to be due to a 
caruncle. 

That pain between the shoulders, which makes us study our materia 
medica for the red thread is sometimes cured by anchoring an unmoored 
organ. 

I recall a case diagnosticated as gall stones by an eminent physician 
— which Dr. E. S. Bailey cured by repositing a right ovary — I had 
failed to eliminate the "gallstones" and sent her, because of prominent 
pelvic symptoms, to Dr. Bailey. 

One more case I would recite because of its obscureness and the var- 
ious diagnosis made by eminent physicians. The chief symptom was 
pain — paroxysmal— of a griping character and always located in the 



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THE CLINIQUE. 209 

right iliac. Accompanying this was a sense of nausea with emaciation, 
never at any time vomiting nor jaundice. The pain bore no definite 
relation to the menstrual period. A physical examination revealed an 
enlargment in the right side which was freely movable — the stomach 
distended and enlarged, extending about three inches below the navel. 
So the diagnosis ran — movable kidney, ovarian tumor — ulceration of 
the pylorus and of course that every day omnipresent, ever recurring 
disease appendicitis. The knife revealed an inspissated and greatly en- 
larged gall bladder, encasing an enormous stony formation. 

So we plainly see how easy it is to err. I am reminded again and 
again of Dr. Ludlam when he would say to his classes: " Be careful or 
you will find what you are looking for." 

Because of the anatomical relations many reflex symptoms may arise 
and do arise, and pain is but an indicator; it but points the way towards 
more careful search for the associating symptoms. 

In all that I have said I have not brought forth a new idea nor added 
one jot of helpfulness along the lines of our study. I have made an ef- 
fort but to emphasize pain as a symptom, not because of its prominence, 
but because of its relationship to other symptoms. Let us beware of 
hit and miss proceedings. This is pus — surely that is a growth — re- 
gional in its scope; but let us locate; let us find its true diagnostic 
value — and thus shall we know the purpose of pain. 



THE PHYSICIAH— AITD THEN SOME.* 

FRANK WIELAND, M. D., CHICAGO. 

It seems fitting, in opening another year of our City Society's work, 
to consider not only all that the physician is, but all that he might be 
that he is not. There is no other profession that allows of such broad- 
ness of personality; there are few that so narrow a man as that of med- 
icine. I was talking with a man of affairs recently, and he struck the 
keynote of the whole matter thus: "Why is it that your very best 
physicians and surgeons can talk of nothing beyond their lines of 
work? When it comes to things of general interest, they are as dumb 
as sphynxes. And they have little loyalty to each other. Each of 
them is secretly at war with every other one. This is a natural result 
of their limited horizon. They are their own sun, moon and stars, and 

•Read as the president's address at the 100th meeting of the Chicago Homeopathio 
Medical Society, Oct. 25, 1006. 



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210 THE CLINIQUE. 

are thus blinded to the larger things of life, or the beautiful and broad- 
ening influences of life." 

Now this was a severe arraignment, but it is in a measure true. 
Considering that we have but one life to live, of the nature of which we 
are at all sure, I think that the majority of us do not make the most of 
it. The whole world of art and literature and philosophy, to say noth- 
ing of the very primitive art of conversation is lost to us. 

Some of you will urge that those, devoted to a profession which has 
for its object the saving of life, have no time for anything else; and 
that the good one does is a sufficient reward, and quite makes up for all 
the sacrifice it entails. As in all fallacious logic, the conclusion is wrong 
because the premises are faulty. There are few men who take up the 
study of medicine from an altruistic motive. 

If they did, they would be failures. One takes up medicine to earn 
a living. He becomes capable from a sense of pride. He does much 
charity work, because he can't avoid it. He does this willingly, be- 
cause he is a gentleman, and secondly, because it soothes his conscience. 
There is really no reason involved in the practice of medicine, per se, 
that makes it necessary and proper for a physiciau to neglect every- 
thing else. No matter how hard he strives, there isn't one physician 
in a thousand who will be remembered for his work ten years after his 
death. Is it worth while, then, for one to be a physician only? 

The carelessness of physicians in general in regard to the other 
things of life is not universal, to be sure. There are exceptions. 
Oliver Wendell Holmes is rarely thought of as a physician. Dr. Weir 
Mitchell is a prolific writer of fiction, not a weighty writer, but his 
avocation has given many people pleasurable reading. Even in our 
own city our radical Dr. Lydston is known more by his wonderful use 
of the English language than as a genito-urinary specialist, and he is 
very capable in the latter. These examples could be multiplied indefi- 
nitely, to show that many physicians do get out of the routine of their 
work. 

I happened once in the office of one of our prominent physicians, 
and found him among bottles of badly decomposed urine, struggling 
away over a hitherto untranslated essay of Swedenborg. "I can't, to 
save my soul," he said, u find the reason for that ablative case." This 
same man, by street-car study, has gained a reading knowledge of 
French and German. All of this has been of great satisfaction to him, 
and his profession has by no means suffered. 

I remembered of having read in Harper's of three books that had ma- 
terially influenced modern thought; whose influence would be felt after 



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THE CLINIQUE. 211 

most of our books of today were forgotten. I had not read any of them, 
and of two of them, I had never heard. I think I felt a little distressed 
that I should have no acquaintance whatever with books that had dom- 
inated thought in three great nations. I spoke of this to a physician 
friend, a specialist of unpsual ability. He added to my discomfiture 
by not only giving me the plot of each story, but by telling me of other 
works of each author. The books were Gorky's ( 'Gordaieff , n Hardy's 
"Jude, The Obscure," and Gauthier's u Madame Bovary," not one of 
them a usual book. Here is one man who could accept a dinner invi- 
tation, and not sit dumb, because denied the privilege of talking on his 
specialty. 

It is needless to say that my ideas are directed towards the younger 
men of the profession, who are so apt to be filled with only the thought 
of financial success, forgetting that one cannot live by bread alone. 
The period of waiting can be made a very fruitful period. He can re- 
new his acquaintance with his old text-books, or review his French and 
German, and be accomplishing as much for himself as if he were read- 
ing a Medical Journal. There is less and less a place in medicine to- 
day, for medicine only, and no conscientious man prescribes for a pain 
here or a pain there. There never was a time when a pleasing person- 
ality and the ability to fit into surroundings were as great an asset as 
now. One needs the grace of God in his heart, which is evidenced by 
being cheerful and clean, and changing one's linen occasionally. I am 
not disparaging the essentials of medicine; I am only regretting the 
limitations that are put on these essentials. A young man was sitting 
in my office recently, and he was dilating on his prospects. u I expect 
great things of myself " he said, " I was third in my class, you know." 
And still I felt sure that he never could succeed, for his mouth showed 
unmistakable evidence of a lunch of eggs, and his finger nails were 
blacker than the despair of a lost soul. Such a person has no place in 
the practice of medicine of today, because he lacks the essential feature 
of cleanliness. 

I wonder sometimes if we who are teachers are not responsible for 
many of the deficiencies in our students. We teach them the things 
they must know to pass a state board examination, but neglect to 
emphasize the things that tend to make them successful men. You 
that remember Dr. Ludlam, ask yourselves why you remember him. 
You will think of his skill, and of his results, both worthy of remem- 
brance ; and then you will think of his charm of manner, and his un- 
failing courtesy, and will realize that it was these latter that made him 
the idol of his students and patients, and won for him the admiration 
of the whole profession. 



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212 THE CLINIQUE. 

So in recapitulation : The young men with time to spare can put it 
to good use by reading good books, and it isn't necessary to go beyond 
the English language to do it. I think it is a mistake to read all the 
editions of the daily papers, when one might better be reading some- 
thing else. I think an occasional day in the parks is worth more to a 
man than every day in the clinic ; and an occasioual day at the Art 
Institute is worth the price of an office hour.' We've all got to earn 
our daily bread, to be sure, and this is no hardship. It helps to keep 
us decent. But life is a very large thing, and needs to be lived in a 
large way. There is no one so in need of its largeness as the physician, 
for he must meet every sort and condition of individual under trying 
circumstances. He needs everything that will make him fit. Let him 
measure the effectiveness of his life, then, by the number of laparoto- 
mies he has performed, by the number of deliveries he has effected, or 
the number of post-mortems he has held, for all of these are perfectly 
legitimate measures of activity. But let him measure it more and 
of tener by the welcome his patients accord him, by the inspiration of 
confidence his presence affords, and by the love of little children. 

When I think of all that is denied me, in the way of the ordinary 
joys of life, because of a profession that allows so little time to its ad- 
herents, I am impressed with the tragedy of it. It is like the old fable 
of Tantalus, with something always within reach, yet always denied. 
For myself, physician as I am, I should rather have written " In 
Memoriam," or to have the spirituality to write it, than to have written 
the Organon. I should rather have written anything that Walter Pater 
has written than to have written anyone's " Practice of Medicine.'' 
The influence that Tennyson and Pater will have on the spiritual side 
of life will be greater than Hahnemann will have on the physical. 

Now you that have followed my line of thought will see how easy it 
is to make this paper one introductory to an evening on genito-urinary 
topics, yes, even more than easy, even proper and fitting. I am con- 
stantly asked by people, usually those whom I am treating for venereal 
troubles, how I can bring myself, if I am of refined tastes, to treat such 
diseases. Tact and a regard for my daily bread forbid my saying that 
it isn't the disease that is distasteful, but the morals of the individual. 
If in coccus life there is an aristocracy, a social scale, I venture to say 
that at the very top, stands the gonococcus, as the arbitrator of " Who's 
Who." For he is as old as history. He can look back thro' the ages, 
thro' generations of kings and peasants, and say, " They were all mine. " 
He can regard the ills of mankind and say, " In their causation, I have 
been the greatest factor." He is also the very poet-laureate of coccus 



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THE CLINIQUE. 213 

life, for he is the product of passion. Of passion, you know poets have 
always sung. However, we ought to distinguish between passion, 
which is a noble emotion, and nastiness, which is not unqualifiedly so. 
If all the research work in all the laboratories of the world could be 
put to work on the study of genito-urinary diseases and their final erad- 
ication, all other diseases could afford to wait. Serious-minded men 
know this. That is why we have made this first meeting of the year, 
of the City Society, a genito-urinary evening. 



HOMEOPATHIC REMEDIES IN NEUROLOGY. 

N. B. DELAMATER, M. D., CHICAGO. 

The term " Homeopathic Remedies " from frequent use has come to 
convey a definite and fixed idea. Notwithstanding the fact that no 
remedy is homeopathic, or that any remedy may be so. The home* 
opathicity depends entirely on its being administered in accordance 
with the law of similars. 

There seems to be a peculiar psychical condition among physicians 
that impels a large majority, the instant they hear the term neurology 
to say: "There is no use, we cannot understand nervous diseases, and 
there is no cure for them anyway." I am obliged to admit that there 
is some ground for this feeling. It is, however, poor ground, support- 
ing nothing but weeds. There are two marked errors, that are in the 
main responsible for this false impression. The main one, I believe, 
is the tendency on the part of writers and teachers on neurology, to put 
too much emphasis on the few incurable nervous maladies that are at the 
same time showy, in that the main symptoms are peculiar and easily 
demonstrated. I admit a clinic of five or six cases of locomotor ata^yr 
is quite sure to make a hit. The general practitioner and the student 
alike, however, almost necessarily retains in his mind vividly that on 
which most emphasis is placed, and thinks very little about the very 
much larger number of nervous diseases that are easily diagnosticated 
and are as amenable to treatment as any other disease. He somehow 
seems to think these few incurable diseases cover the entire field of 
neurology. He fails to recognize the fact that he is himself constantly 
diagnosticating and successfully treating a full proportion of diseases 
belonging to neurology. 

I will ask you then to disabuse your minds of these two errors the 



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214 THE CLINIQUE. 

incurability of nervous diseases and of their being exceptionally diffi- 
cult to understand or manage. Having done this we are in position to 
consider a very important element in the treatment of neurological 
cases, the application of the great natural law of cure. That this law 
like every other law of nature, has its limitations we must freely and 
honestly admit. That there are neural cases in which the law is not 
applicable cannot be successfully disputed. In the by far larger num- 
ber of these diseases in which the law is applicable, the object to be ob- 
tained may be either palliation or relief of certain symptoms, or cure. 
When palliation is the desire, the remedy must be selected according- 
to the similarity of the drug symptoms, to those symptoms in the patient 
we desire to palliate plus the accordance of other symptoms present. 
That is we are to get as near a totality as possible, but must put the 
greatest emphasis on the one most prominent, or the group to be palli- 
ated. Where cure is the goal sought, the similimum must be obtained 
by one of two methods. 

In acute diseases and those resulting from direct external causes, we 
should select the similimum by comparison and sequence of the drug to 
the symptoms or abnormal manifestations of feeling and condition com- 
ing on with, or during the course of the disease. That is seeking a 
similimum to the disease. In that very large class known as functional 
diseases, and many resulting from causes within, the key or pointer to 
the similimum will be found in the mental and emotional symptoms pres- 
ent. Here you will first try to find the mental or emotional similimum 
as near as may be, and then the similimum to other disease symptoms 
present. 

In the fewer cases the result in the whole, or in part from heredity, 
from predisposition or tendency, from any prenatal influences or from 
causes entirely within the patient, a radically different method should 
be followed. In these, the fundamental trouble does more than simply 
modify manifestations. It is the entire determining factor. For the 
most part they are the graver organic diseases. Here the similimum 
will be found in the ego of the patient. In those things that are not 
abnormal to the patient, but abnormal in that they vary from a general 
or normal standard. Those things in which the patient normally and 
physically differs from other individuals. The special peculiarities of 
temperament, of modes of thought and action tljat makes the individ- 
ual patient differ from every one else. In short all that goes to make 
the individuality of the patient. In other words the similimum is 
found in the accordance of the drug and the individual or patient. In 
acute mental diseases from external causes, select the similimum by 



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THE CUNIQUE. 215 

comparison with disease symptoms. In these mental cases in which 
the cause evidently is within, select the similimum by comparison with 
the individual plus the present symptoms. 

Of course under all methods, modalities as to aggravations and amelio- 
rations must be fully considered. As it is evidently impossible in a short 
paper to give a list of neural diseases with appropriate remedies and 
equally impossible to give a list of the remedies that are useful in alle- 
viating or curing neural diseases with special symptoms, allow me to 
simply illustrate. 

In cerebral meningitis for instance, an acute disease usually result- 
ing from some external cause, the attack comes on suddenly; there is a 
more or less marked chill and vomiting, or there may be slight fever, 
with a chilly sensation if bedclothes are moved, or the patient moves 
ever so slightly. There is contraction of the pupils, marked headache 
with usual signs of malaise. Pulse not very rapid, but quick and 
sharp. You observe that the patient is very restless and that every 
movement, even drinking, aggravates the pain. Place your hand on the 
head and you find it very hot. In this case aconite is evidently your 
remedy. 

Now another case, the patient has had more or less headache in par- 
oxysms, at times throbbing, there has been general malaise. Now you 
are called because of an attack of furious pain in the head, the face is 
pale, there is evidently a sudden onset of fever, pulse is rapid and rather 
hard, the patient is very talkative and the pupils very small. In this 
case it is equally certain your remedy is belladonna. 

Later in the case there is delirium, very violent, eyes bright and 
shining, coma with pale face, or alternating with convulsions and 
throbbing of the carotids. Here again belladonna is called for. But 
suppose instead of the pale face, it is red or even bluish instead of 
bright, there is an ugly expression, and there is no alternation of coma 
and convulsions, either present and continuous, the remedy then would 
be stramonium. 

A case of epilepsy presents, due investigation shows it to be an idi- 
opathic case. The patient is otherwise in good health, there are prac- 
tically no symptoms except those of the attack, and even in these it 
seems impossible to detect any one that is especially peculiar. We find 
a dissipated heredity, that from babyhood there has been a marked 
tendency to take cold with changes of weather; a delicate slender build, 
sallow complexion, dark hair, rather rigid fibre, but mild and easy dis- 
position and yet irritable, a tendency to what is termed biliousness. 
Suppose you observe what is known as a yellow saddle across the nose, 



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216 THE CLINIQUE. 

prominent gums that bleed easily, a marked sexual desire, but weak 
genitals, sweating and itching of scrotum, your remedy is sepia. 

The fact I desire to make supreme in this paper is that my experi- 
ence has taught that if you will devote the necessary study, close ob- 
servation and thought, our record in the treatment of neural diseases 
can be made as great if not greater than any other line. I believe 
it to be the field par excellence for cure. Our results can be made 
to so far outweigh that of the regulars as to demand even their atten- 
tion. 



FACTS RELATIVE TO TUBERCULOSIS. * 

H. V. H ALBERT, M. D., CHICAGO. 

Our present knowledge of tuberculosis reveals the following facts: 
It is an acute or chronic disease caused by development of the tubercle 
bacillus. It is characterized by nodular lesions or diffuse infiltration, 
which may undergo secondary changes. Any tissue may be involved. 
It is an infectious disease, the acute and extreme manifestations of which 
require the aid of a mixed infection or favorable predisposing acute or 
chronic conditions. In other words, the bacillus alone and unaided by 
other causes is not always prone to work the dire effects which are as- 
cribed to it. 

That the method of infection must be discovered and prevented to 
safeguard us against its unusual danger and to help us in the treatment. 

That predisposing factors must be constantly guarded against and 
corrected so far as possible in order to make any reliable headway in 
treating it. 

That infections other than that of tuberculosis must be thwarted in 
order to minimize the possibility of the disease. 

That environment is a more prolific cause than we realize, and that 
we are not yet doing our best in this line of protection. 

That occupation is too rarely regarded as a predisposition and that we 
do not frequently enough take this into consideration; in this respect 
also we are still sadly deficient in our educational efforts to thwart this 
disease. 

That local conditions like chronic or recurrent bronchitis, for in- 
stance, are too frequently disregarded in their tendency to develop fav- 
orable conditions for the implanting of the bacillus. 

That chronic diseases like organic heart disease, arterid-sclerosis, 
*Read at Central Illinois Homeopathic Association. 



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THE CLINIQUE. 217 

nephritis, cirrhosis of the liver, etc., may create a physical debility 
which encourages the contraction of this disease. 

We have learned that entero-colitis in children may predispose to 
tabes mesenterica and that pulmonary tuberculosis may develop in the 
young soon after a specific infection like measles, scarlet fever, whoop- 
ing cough, etc. 

That pneumonia is always a dangerous predisposition and it is fre- 
quently a forerunner of tuberculosis, especially when resolution is im- 
perfect. 

That pleurisy is usually a sign of impending pulmonary tuberculosis. 

That even traumatism must be feared as a predisposition as, for in- 
stance, a knee injury may establish a tuberculous arthritis, while an 
injury of the head may develop tuberculous meningitis. This is possi- 
bly explained by the theory that the bacilli receive a stimulus to their 
growth by the contusion of the parts and the diminished phagocytic 
activity following the injury. 

Treatment of tuberculosis. This has already been intimated by the 
outlines I have referred to. It must, of course, include a most pains- 
taking study of the pathology and the habitat of the disease, the pecu- 
liarities in each case, the heredity, the predisposition, the tissue in- 
volved, as well as the receptive tendency and the resisting power of 
the patient. 

The most essential feature of treatment is a perfect and -early diag- 
nosis ; we must assure ourselves by a satisfactory differential diagnosis 
when we are not dealing with this disease; and when we are satisfied in 
this respect we must see to it that any other cause of the illness does 
not predispose to this disease or develops a latent condition which in- 
cites its acute manifestations. The early diagnosis alone makes the 
treatment possible or successful ; to this purpose we must bend all our 
energies and augment our diagnostic ability as well as exercise our 
caution and care ; it is better by far to make a mistake in proclaiming 
tuberculosis than in denying it ; in the first instance we guard against 
it and make our treatment possible, while in the second instance we 
allow it to become a fixed and possibly an incurable danger. 

To cure the disease we must apply our therapeutic efforts to its in- 
cipiency; hence, an early diagnosis is absolutely essential; it is easy 
enough to name the disease in its advanced stage when the clinical 
symptoms are distinct and a cure is questionable; it is a far different 
and far better thing to decide upon the disease in its early stage and 
employ our treatment when it may be efficient. 

It is not my province in these notes to take up the prophylaxis which 



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218 THE CLINIQUE. 

is a civic duty as well as a physician's; nor to mention the necessity of 
segregation, registration and other requirements which the state should 
control; we are unfortunately obliged to treat the disease, or the disease 
plus the patient. Many of the early ideas of treatment have wisely 
been abandoned. The aim to destroy the bacillus within the body has 
been abandoned for the more scientific aim to make it inocuous by 
treating the patient and establishing if possible the equation of physical 
resistance. Antiseptic inhalations (in pulmonary tuberculosis) are not 
now relied upon except for their possible relief of irritable and inter- 
vening symptoms. Internal parasiticides, so far as my experience 
goes, are a failure and often a mistake. I do not believe that creosote, 
guaiacol, or codliver oil have any direct effect except as they are in- 
dicated; often their use is detrimental. Tuberculin, in any form, 
according to my belief, is only serviceable as it is of diagnostic value. 

We thus are reduced to the two apparently efficacious methods of 
treatment which are specific, viz. : Climatic and the development of 
physical resistance. To these I irould add the axiom that the patient 
must be treated according to the symptoms which are expressive of the 
individual pathologic condition; that I am disposed to call homeopathy 
and to this I feel it essential to add the specific treatment already mentioned 
which scientific investigation has demonstrated to be valuable. Under 
the specific treatment I will not take time to discuss the climatic re- 
quirements or the tent or sanatoria ideas with which we all are familiar 
and agreed. Neither will I expatiate upon the subject of physical de- 
velopment or resistance, for we know well how that must be undertaken 
in individual cases and in different environments. 

I prefer to give the few moments allotted to me to that other essen- 
tial which I term homeopathy. . I may differ with many of you when 
I say that in this respect I refer to the use of remedies in their physiolo- 
gical relation to a clinical symptomatology which is expressive of an ex- 
isting pathology; in other words, I prefer to rely upon the known ac- 
tion of the remedy rather than the entire and often unreliable symp- 
tomatology which we have allowed to lumber our materia medicas; still 
further I wish to say that it is the proving of the remedy which has 
given us a safe symptomatology; we should rely upon this rather than 
the multitudinous and often contradictory symptoms which we may have 
committed from our text-books like parrots. It was Hahnemann who 
who called attention to the use of the indicated remedy and this sug- 
gestion has a wider significance than we always appreciate; it does not 
refer alone to the administration of medicine; it calls for whatever help 
is essential or demanded by the greatest knowledge of the case in hand; 



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THE CLINIQUE. 219 

if the lung is debilitated, it calls for the best of climatic conditions; if 
the health is depreciated, as it always is, of course this principle of 
treatment must include the dietetic, physical and tonic requirements 
which will rejuvenate the lost vitality; if environment or heredity tend 
towards this disease, then here is an indication which points to a rem- 
edy; if there are signs which look to local lesions which are contribut- 
ing factors, then here is another indication which should direct us; 
and so on, ad infinitum, we may find remedial illustrations of this kind. 
I believe that it is right to go even a step further and to state as a tru- 
ism that any remedy which by its specific use has helped to overcome 
the pathology is by all means indicated and demanded because we know 
it produces results. 

I do not say this to uphoid homeopathy or to make a therapeutic 
method homeopathic before I use it. I mention it to show that in 
reality the homeopathic principle has a wider meaning than that which 
is defined by the text-book demand for a remedy and that it cannot ap- 
ply if we isolate its usefulness to this one narrow idea alone. On the 
other hand I believe that if we ever attain a method for the cure of 
tuberculosis, it must include this idea of individualization in treatment. 
We cannot rely upon our specifics alone nor can we rely upon our little 
pill alone. The cure for this dread disease must be preventive, antici- 
pating, and indicated; not climate alone, not creosote alone, not the 
homeopathic remedy alone. 



ECZEMA— A COMPARATIVE STUDY. 

C. D. COLUNS, M. D., CHICAGO. 

This very old topic is presented because of its being so difficult. It 
has always remained a live topic, and the writer has endeavored herein 
to simplify the study of this complex disease by arranging its chief 
symptoms in a classified manner. 

Eczema is not so difficult if the student would but stop to consider 
two points: First, to classify eczema into its elementary divisions; 
secondly, to master about five or six of the cardinal symptoms that are 
always true of all forms of eczema, such as infiltration, itching, in- 
creased redness, indefinite border lines, and sometimes oozing, scaling 
and crusting. 

Eczema may be defined as an acute or chronic non-contagious, in- 
flammatory disease of the skin beginning in one or more of the elemen- 



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220 THE CLINIQUE. 

tary lesions of the skin such as papules, vesicles or erythema and at- 
tended by infiltration, itching, increased redness, indefinite border 
lines, and sometimes oozing, scaling and crusting. Note that in the 
definition nearly every fundamental principle and symptom of eczema is 
set forth. Eczema has so many complex and multiplied lesions and 
appearances, that unless the practitioner keeps ever before him the 
chief and fundamental symptoms of eczema he is liable to become con- 
fused with symptoms of secondary importance and miss the diagnosis. 
Let us enumerate these cardinal symptoms and speak of their individ- 
ual importance. 

Infiltration is true of all forms of eczema both acute and chronic, 
and is one of the ever present symptoms. The extent of in- 
filtration differs in different cases, but is one of the first symptoms to 
be thought of, and the presence of which is almost diagnostic. This 
gives to the skin its leathery feel, and increases its normal thickness 
several times. 

Itching is one of the ever present symptoms of eczema, which may be 
mild or severe according to the case. In very acute cases, the itching 
amounts to almost a painful sensation. The itching is usually increased 
by heat, moisture, friction and by the warmth of the bed. 

Redness is always present to a greater or less degree. This may not 
be so manifest on the surface when covered by a heavy layer of scales, 
but is apparent upon removing the scales. Eczema is always attended 
by a congestive or inflammatory pathology and the redness is an attend- 
ing factor. 

Indefinite border lines is the usual expectancy in eczema, and attends 
all forms except the so-called eczema marginatum or eczema rubrum. 
This indefinite border line is due to the fact that the pathology tapers 
ottt by slow gradations from pathologic into the healthy skin. 

Scaling is always present to a greater or less degree, but the scales 
are sometimes masked by an overwhelming exudation as is true in the 
acute inflammatory cases, until the entire epidermis may be thrown off 
in a mass, and the underlying tissues appear only as a reddened and ooz- 
ing surface. 

Crusting is present when there has been a pre-existing or an attend- 
ant oozing. All eczemas are more or less catarrhal and oozing of serum, 
and sometimes droplets of blood are often found at some time during 
the course of the disease. Where there is no oozing, there will be no 
crusting. 

A given case of eczema does not necessarily have all of these symp- 
toms at the same time, but three or more of them will be present and 



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THE CLINIQUE. 221 

this is sufficient to make the diagnosis. Eczema possesses several 
peculiarities characteristic of eczema alone. It is a restless disease, an 
ever changing disease, running its course from the acute to the chronic 
and may be transformed again from the chronic back into the acute. 
One form of eczema may run into another, as the erythematous may 
become the squamous, the vesicular becomes the pustular and the pustu- 
lar variety frequently becomes the so-called eczema rubrum. In acute 
cases a considerable degree of heat, swelling and even pain is often ex- 
perienced in the part affected, ancj nearly all forms of acute and sub- 
acute eczemas are attended by from one-half to two degrees of body 
temperature. 

Eczema is classified into four primary and two secondary divisions 
or types, based on the predominating symptoms and their underlying 
pathology. Eczema erythematosum, eczema papulosum, eczema vesi- 
culosum, eczema pustulosum, eczema squamosum and eczema rubrum. 

Eczema erythematosum as its name indicates is the inflammatory 
form of the disease, or that form in which the inflammatory symptoms 
predominate, hence its name. Eczema papulosum is that type where 
papules are the predominating lesion. Eczema vesiculosum and ec- 
zema pustulosum can be disposed of in the same manner, for their pre- 
dominating lesions are vesicles and pustules. Again, eczema squamo- 
sum is indicative of the scaling type of the disease and bespeaks an in- 
tense infiltration pathology which interferes with the nutrition to the 
epidermis and hence extensive exfoliation. Eczema rubrum is the red 
variety of the disease and obtains its vivid hue by virtue of the fact that 
its epithelium has all been thrown off by the intensity of the exudate 
from the congested stratas beneath. 

Other than for the sake of classification and convenience of study, 
these names or divisions of eczema are of but little value, for as already 
stated, the fundamental principles of each variety are all the same. 
They all have itching, redness, oozing, crusting, scaling, indefinite 
border lines and tend to become confluent, and negatively none of 
them ulcerate or show any tendency to degeneration, and never form 
scars, though often there remains a pigment deposit which is the only 
relic of a pre-existing eczema. 

He who masters eczema, masters half of dermatology, for it is one of 
the most universal diseases known as it attacks all ages, all races, all 
colors, all nationalities all over the world, and at all seasons of the year. 
And the symptoms of eczema wherever found, under whatsoever clim- 
ate or race of people, are all the same. 

The causes of eczema ate as varied as its symptoms. No doubt ex- 



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222 THE CLINIQUE. 

ists in the mind of the writer that eczema is the product of irritation 
either from within or from without or from both. It is doubtful, in- 
deed, if eczema develops in the perfectly healthy from external irri- 
tants alone without a suitable background. In other words, some con- 
stitutional impairment, a faulty metabolism, a defective elimination or 
an impoverished condition of the blood or nervous system. Over feed- 
ing is as harmful as an improper diet, and especially so if attended by 
constipation and auto-intoxication. The irritation produced by cold 
winds, dust and changeable weather, and th$ friction of underwear are 
all contributing causes. The handling offisertaia drugs and chemicals 
will irritate the skin, and many tradesmen find their occupation pro- 
ductive of the disease. 

Its pathology is one of infiltration, congestion, venous stasis, lymph 
stasis, inflammation and catarrhal exudation of varying intensity. The 
chief seat of the pathological process is in the papillary and reticular 
layers of the skin. The intra-vascular spaces become engorged with 
serum, lymph, and round cell infiltration. Hypertrophy of the connec- 
tive tissues takes place, and together with the infiltration cause a thick- 
ening of the skin. A marked increase of the pigmentary deposits in 
the rete mucosum takes place. Fat cells undergo absorption from press- 
ure. In chronic cases the epidermis is involved only secondarily by a 
necrotic process due to lack of nutrition. 

The diseases with which eczema is liable to be confused and with 
which a comparative study is required are: Dermatitis, erysipelas, 
lichen, scabies, psoriasis, seborrhea, papular syphilis, herpes, impetigo 
and sycosis. 

Dermatitis is recognized by its acute symptoms and transitory exis- 
tence. It is attended with pain and swelling rather than itching, and 
usually follows some trauma or local irritation, and is marked by 
edema rather than infiltration. 

Erysipelas is violent in its onset and rapid in its course. It attacks 
not only the skin but the subcutaneous tissue in one inflammatory 
mass of swelling, pain, edema and often covered by vesicles or blisters. 
Its abrupt margins definitely defined and spreads by peripheral exten- 
sion and is contagious. 

Lichen is always a papular disease and shows no tendency to become 
confluent. The papules remain isolated, arrange themselves in rows 
with healthy intervening spaces, and shows no tendency to become 
moist, oozing nor crusting, and is usually definitely marginated. 

Scabies is a pustular disease having minute lesions attended by great 
irritation, itching and scratching, the lesions usually beginning upon 



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THE CLINIQUE. 223 

the hands extending to the arms, breasts, abdomen, buttocks and gen- 
itals presenting a great mass of mixed lesions such as scratch marks, 
blood crusts, pus crusts, scales and debris, and all symptoms aggravated 
by the warmth of the bed, and is very contagious. 

Seborrhea has its chosen locations as the scalp, shoulders and chest 
and genitals. It is always recognized by its greasy crust and pale pink 
base and attended by but slight subjective symptoms. 

Papular syphilide is a papular eruption more or less generalized over 
the body, attended by but few scales and no subjective symptoms. 
The intervening spaces between the lesions are healthy and show no 
inclination to infiltrate, ooze nor itch. The syphilide presents a cop- 
pery hue, the diagnosis of which can easily be CQrroborated by a history 
of specific infection. 

Herpes is always a vesicular disease, acute in character and runs a 
rapid course. It is attended with more pain than itching and more 
swelling and edema than infiltration. It is usually limited in area, 
definitely marginated, sudden in its onset and sudden in abatement. 

Impetigo is throughout a pustular disease. It begins as an infective 
dermatitis upon which a vesicle pustule develops. This rapidly rup- 
tures and dries down into crust upon the skin. The whole lesion 
has the appearance of being superficial, a crust stuck upon the skin 
rather than into the skin. It is contagious and autQ-infectious, and 
rafter healing leaves only a slight roughened spot. 

Sycosis is a pustular affection which invades the hair follicles chiefly 
of the bearded portion of the face. It is marked by inflammatory 
papules and pustules with falling of the hair. Its course is chronic and 
relapsing with more or less inflammation of the skin and attended by 
heat and burning rather than itching. 



THREE CASES OF EMBOLUS OF THE CENTRAL ARTERY OF 

THE RETINA. 

C. A. HARKNESS, M. D., CHICAGO, ILL. 

While embolus of the central artery of the retina is not a common 
•disease, it is a very serious one when it does exist, and only when rec- 
ognized early is it possible to cure it. Occasionally there exists a small 
branch of the artery which nourishes a part of the retina, so saving 
some vision for the patient. Such a case is reported by Dr. Edgar J. 



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224 THE CLINIQUE. 

George, it being a case of double embolus. The patient's field of vision 
is very much contracted, but is quite acute. 

The etiological factors in this disease are usually some heart lesion, 
sclerosis of the arteries, rheumatism, aneurism, Bright's disease and 
pregnancy. The most common cause is a valvular heart lesion. In 
some cases it is impossible to find any cause for the trouble. In only 
one of the cases which I have to report was there found any condition 
predisposing to an embolus. In that one there was a mitral insuffi- 
ciency and a sclerosis of the arteries. 

The treatment of course depends partly on the etiology. At the time 
of the attack the first object of the treatment is to dissolve the embolus, 
if possible, and to push it down into one of the smaller branches of the 
artery where it will do little damage. This last is best accomplished by 
inhalations of amyl nitrite, which stimulating the heart causes a greater 
blood pressure and a dilatation of the blood vessels. To absorb the em- 
bolus arnica is the best homeopathic remedy. In all cases after the im- 
mediate treatment has been given the underlying cause should be 
treated. 

To secure results from the treatment it is absolutely necessary to see 
the patient early and to recognize the condition and institute treatment 
at once as these cases which I have to report will show. 

The diagnosis is made on the sudden loss of vision, sometimes ac- 
companied by a cloudiness or haziness around lights, with little or no 
pain and the ophthalmoscope findings. The ophthalmoscope shows 
the arteries diminished in size, sometimes appearing only as indistinct 
lines, the veins contracted and broken, and the retina anemic. Occa- 
sionally there will be seen hemorrhages into the retina. Unless the 
circulation is restored atrophy of the entire retina occurs. 

The first case came into Dr. Edgar J. George's clinic at the Chicago 
Homeopathic Medical College. He was a conductor on the elevated 
road and said that three weeks before he had passed the physical exam- 
ination easily. About a week before he came to the clinic he suddenly 
lost the vision of the left eye. There was no pain and he only acci- 
dentally discovered that he could not see with the left eye. Right 
vision was 20-20. Left vision 5-200. Opthalmoscopic examination 
showed the typical findings of embolus of the central artery, arteries 
diminished in size, veins broken and smaller, retina and optic nerve 
head anemic. Arnica was given to absorb the embolus but with no 
results. In this case no cause for the condition could be found. The 
vision gradually fell until it was entirely absent in the left eye. 

The second case was a Catholic sister, who also suddenly lost her 



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THE CLINIQUE. 225 

vision. She said that she had been using the eyes very hard for a 
week, and at the time was straining them in order to finish reading the 
proof of a magazine published by the school she was teacher in. Sud- 
denly she felt as if something had hit her in the eye, the lights looked 
peculiar, being hazy and having a halo around them, and she could not 
see with the left eye, but she had absolutely no pain. The patient was 
seen a few hours after she was first attacked and the diagnosis was 
made on the opthalmoscopic findings. Inhalations of amyl nitrite were 
given at once and arnica was given internally. The first day she could 
only count fingers at two feet. The next day her vision had become 
20-80. Two weeks later left vision was 20-60. Under atropine it fell 
to 20-120. With glasses vision became 20-20. 

The last case came into the Thursday clinic at Hahnemann Medical 
College. He gave a history of having strained to lift a bucket of coal 
two weeks before. Immediately vision was lost in the left eye. The 
opthalmoscope showed a typical case of embolus. In this case a mitral 
insufficiency and a sclerosis of the arteries was found furnishing a good 
cause for the embolus. No treatment for the eye was given owing to 
the time which had elapsed before he came to the clinic. He was re- 
ferred to Dr. Blackwood's clinic for treatment of the heart condition. 

In only one of these cases was there any improvement and that one 
was seen early and it was impossible to push the embolus into one of 
the small branches by the use of amyl nitrite. (Treatment is of little, 
if any, benefit after 48 hours, owing to the atrophy which soon begins.) 

In all of these cases the left eye was the one affected. Just why that 
eye rather than the right should have been the one to suffer it is im- 
possible to say and it cannot be said positively that one eye is more 
often attacked by the disease than the other and yet the fact that in all 
these cases the same eye was affected would lead to the supposition that 
for some reason an embolus is more easily carried into the central 
artery of the left eye than the right eye. 

To sum up the above } wish to emphasize the absolute necessity of an 
early diagnosis and immediate treatment if any results are to be ob 
tained. It is, as stated in the beginning, a rare condition, but also a 
very difficult one to benefit in any way and so what treatment is possi- 
ble should be instituted at once. 



Pulsation in the course of an artery should not lead to the hasty con- 
clusion that one is dealing with an aneurism. A tumor overlying a 
large vessel, and also a vascular sarcoma of the bone, may simulate an 
aneurism very closely. — American Journal of Surgery, 



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226 THE CLINIQUE. 

PERSONAL EXPERIENCES IN OBSTETRICS.* 

G. H. MOSER, M. D., MATTOON, ILL. 

In coming before you this afternoon I ask you to excuse me for not 
preparing a lengthy paper upon the subject allotted to me, for the rea- 
son that I did not feel that I was able to write a paper of sufficient in- 
terest to entertain you. I realize that practicing medicine and writing 
a paper are two distinct propositions, and not being very proficient in 
the former it makes it doubly hard to be successful in the latter. How- 
ever, I have prepared a few notes that I wish to present on the methods 
and remedies that I have employed successfully in the treatment of 

cases. 

First, the treatment that I have found most successful during gesta- 
tion or pregnancy are as follows: For nausea or vomiting I find malto- 
pepsin (Tilden's), almost a specific. I use this in teaspoonful doses 
first thing on arising in the morning and after each meal, or at any 
time that nausea may appear. If I find any liver complications, such as 
bilious vomiting and jaundice I give chionanthus tinct. 15 to 30 min. 
doses before meals and the malto-pepsin after meals. This treatment 
in a few weeks generally leaves the patient in good condition and no 
further treatment is required. For kidney complications. I have found 
but few remedies that prove of benefit outside of our arsenicum alb. 3x and 
apis mel. 3x and also nephritica (Tilden's). This I give in teaspoon- 
ful doses in a wineglassful of water every three hours until I have free 
action of the kidneys. I also advise the use of an abdominal supporter 
as this reduces the pressure of the uterus and its contents on the larger 
blood vessels that supply the lower extremities and thus avoids impeded 
circulation. Hence no dropsical conditions or varicose veins will ap- 
pear. 

For cystitis: Ferrum phos. 3x and natrum phos. 3x in alternation or 
lycopodium 3x; also nephritica as prescribed above. For pruritis, 
which we find in some few cases, I use locally glycothymoline, 50 per 
cent, solution, applied with cloth three times daily. Also perman- 
ganate of potash % grain to eight ounces of water, applied freely with a 
cloth. Internally natrum phos. 3x every two hours. For constipation, 
calcarea fluor. 6x, night and morning, five grain doses, giving lyco- 
podium 3x and nux vom. 2x in alternation every hour during waking 
hours; also Pettit's pills in obstinate cases, one after meals and at bed 
hour until the bowels act freely, then as required to regulate. 

♦President's address, read at the Eastern Illinois Homeopathic Association, Mattoon, 
IU., 1906. 



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THE CLINIQUE. 227 

Palpitation of heart: Luyties' combination tablets No. 16, consist- 
ing of aconite 3x, cactus 2x, digitalis 3x; three tablets every fifteen 
minutes until relieved. Then as a heart stimulant and regulator I find 
crategus oxy. tinct. very efficient, giving six to eight drops after each 
meal and at bed hour. 

Methods employed at time of delivery: If I find that the pains are 
regular I know the patient is having true labor pains, as false labor 
pains are seldom, if ever, regular. I prepare the patient for ex- 
amination; if presentation is normal and os only slightly dilated I 
wait for further development. If pains are slow and not of sufficient 
force I give Pulsatilla 3x and kali. phos. 3x in one-half glass of water, 
teaspoonful every ten minutes, applying hot, dry cloths over the abdo- 
men. I never use ergot to produce or strengthen pains. To dilate 
the os I find that a few inhalations of chloroform act like a charm. If 
pains are regular and os seems to dilate and the placenta protrudes I do 
not interfere, as this helps to dilate the os and may prevent laceration, 
hut if the pains are not of sufficient force to cause pressure below I 
rupture the membrane, allowing the water to escape and by so doing 
cause a more direct pressure on the fetus and by this contact create 
more frequent and stronger pains. 

To prevent laceration: I use oils very freely, either olive oil or lard, 
preferring the olive oil and especially if head of child has abundance of 
hair or have a slow, dry delivery. 

Abnormal presentations: I have no specific methods as each case will 
suggest the proper thing to do. I might mention that in shoulder 
presentation I find the easiest methods employed by me have been to 
reverse the child to the foot presentation. 

When I use instruments: If after the true labor pains have continued 
for three or four hours and the os is fully dilated, there has been no 
progress I never hesitate to use the forceps. I work only during pains, 
resting between pains. 

Laceration: I repair as soon as possible and if done immediately 
after delivery it will be practically a painless operation; the use of an 
anesthetic not being required. 

Delivery of placenta: I take up the cord (after a few after-pains have 
occurred ) in the left hand, follow the cord with the two fore fingers of 
the right hand into the vagina and lift up the placenta. This will en- 
able the delivery without tension on the cord. 

Post-partum hemorrhage: I remove the clots from the mouth of 
the uterus and use intrauterine injections of creoline, lOper cent. sol. , 
or vinegar and hot water, one part vinegar to two parts of water; one- 



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228 THE CLINIQUE. 

half to one pint of this mixture has never failed to give the desired re- 
sult. 

Severe after-pains: I remove the clots with augur curette or blade of 
forceps if the uterus seems distended. This I find less annoying to the 
patient and just as efficient as using the hand. I find that in many 
cases after removing the clots there are no more after-pains. Should 
they continue I use as an internal remedy magnesia phos. 3x, five grain 
doses dissolved in a teaspoonful of hot water every fifteen minutes un- 
til eased. If this does not suffice, after six or seven hours, (never be- 
fore), I give codeine % grain every hour until relieved. 

Treatment of Nipples : I apply a sol. of tannin and brandy, (for- 
mula, tannin 10 gr. brandy 1 oz. ) Apply after each nursing. As a 
preventive, use night and morning, beginning a few weeks before con- 
finement. Have also used alcohol and common tea, one part alcohol to 
two parts of tea h applied after nursing. 

For Caked Breasts : Iodine and glycerine, equal parts, applied two 
to three times daily affords relief. 

As an after-treatment : I use arnica 3x, bryonia 3x, echinacea tinct. 
20 drops in one-half glass of water, giving teaspoonful doses every hour 
until four to six doses are given ; then every two hours for the next 24 
hours. These remedies seem to reduce the soreness and lessen the 
severity of the after-pains. 

I find another very essential part of the after-treatment is to evacuate 
the bowels and for this I find nothing that equals castor oil in liberal 
doses. After the first 24 hours I give a tablespoonful in a little toddy 
and sugar, ordering the dose repeated every three or four hours until 
the bowel has been thoroughly cleansed of all impacted fecal matter 
that necessarily accumulates during pregnancy. If, after the second 
dose is given, there is no result I use an injection of glycerine and 
water ; 2 oz. glycerine to each quart of water. This I generally find 
necessary after a slow, tedious delivery which may cause slight paralysis 
or inactivity of the lower bowel. 

I seldom use any vaginal douches as I believe that douches will 
cause more harm than benefit by disturbing nature's way of protecting 
the parts. That, at least, has been my experience in those cases where 
I have been called following other physicians who used vaginal douche. 
I generally find a raw, irritated cervix and congested uterus, causing 
other nervous symptoms. However, if I find an abnormal discharge I 
use the augur curette, following it with a vaginal douche, to cleanse the 
parts ; also in case of laceration I use the douche to keep the parts clean ; 
otherwise I advise the cleansing of the outer parts only ; which has 
given me the best results. 



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THE CLINIQUE. 229 

Milk Fever: This we seldom have to contend with but when it does 
appear I prescribe Luy ties' combination tablets No. 86; thr*e tablets in 
hot water every hour until fever is reduced. Generally a few doses will 
suffice. 

Care of Infant: It would be useless for me to dwell upon the clean- 
ing and dressing . the infant, hence I will mention only a few of the 
methods I have used and have found beneficial. I always advise wash- 
ing the eyes with pure water, omitting- the use of soap. I take particu- 
lar pains to cleanse the scalp and thus prevent the formation of scabs. 
I apply a little lard to the scalp and instead of using the talcum powder 
I use lard or olive oil under the axilla and, in fact, in all the folds of 
the skin, especially on the buttocks, which I have the nurse oil freely, 
as the first passage from the bowels, being a very sticky, adherent sub- 
stance and likely to occur very shortly after the child has been dressed; 
and unless these precautions are taken the adhered matter will cause 
annoyance to the child making it restless and very often inspiring the 
nurse with the mistaken idea that it should be dosed for colic or some 
other imaginary ailment. 

Dressing the Cord: I use the cloth well oiled, using antiseptic 
powder only on the abdomen. Decay is necessary to separate the cord 
from the umbilicus. 

For the mucous rales which we often have in these cases, I find 
nothing to take the place of whiskey, glycerine and water; one-half 
teaspoonful each of whiskey and glycerine to one-third tea cup full of 
warm water. Generally one to two doses will be all that is required. 
I always put the child to the breast as soon as the mother has had a few 
hours rest and to induce the child to take hold of the nipple I advise 
the use of a little sugar-water dropped on the nipple or into the child's 
mouth. It seems that after getting a taste of the sugar-water the child 
takes hold readily. 

For Colic: As an internal remedy I find magnesia phos. 3x, one 
grain doses every fifteen minutes until eased to be efficacious. If the 
bowels are inactive and the child has had no passage, I use injections 
of warm water and glycerine with infant syringe. This very often re- 
lieves the colic. I have noticed that the spasms of early infancy are 
very often caused by an inactive bowel, hence I use injections freely. 

For Jaundice: I use either chionanthus or chamomilla; the tincture 
6 to 8 drops in one-half glass of water, giving a .teaspoonful every two 
hours. 

Puerperal Convulsions: In my practice I have had but two cases. 
The first passed away after 24 hours of suffering. Nothing that I was 



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230 THE CLINIQUE. 

able to do seemed to afford any relief. She passed from one convul- 
sion into another until finally death closed the scene. The second 
case, Mrs. M.: NaturaJ. delivery, time of labor two hours, small child, 
no lacerations, normal delivery of placenta. Left patient feeling fine; 
had some headache, not severe. Convulsions began about three hours 
later recurring every 15 to 20 minutes, and having about forty spasms 
in all. I used the entire list of remedies generally prescribed in these 
cases, also hot corn packs, hot blanket pack, alternating with cold packs 
without any result. Finally I used a turpentine stupe over the abdo- 
men for the tympanitic condition, rubbed the limbs and the greater 
portion of the body freely with whiskey, the only alcoholic stimulant 
at hand, and applied a mustard draft to the back of the neck. After 
working in this way for several hours the patient began to relax and 
showed signs deglutition. I immediately pried open the jaws, which 
had been locked for hours, and administered one teaspoonful of whiskey, 
glycerine and water, which she swallowed with difficulty. I repeated 
the dose every five to ten minutes until the act of swallowing became 
less laborious, and the mucous rales in the throat disappeared. I then 
gave a tablespoonful of hot water with a few fever tablets every 20 min- 
utes; three doses in all; as the fever, taken per rectum, registered 
throughout the convulsions from 104 to 106. She soon had profuse 
perspiration and the patient sank into a quiet sleep, with but slight 
signs of any return of the convulsions. After sleeping from 5 to 6 
hours she began to show signs of awakening, but was still unconscious 
and remained in this state for three or four hours, then passed into a 
semi-conscious condition from which she seemed to improve gradually 
day after day unjil within a few weeks she had apparently entirely re- 
covered. I gave, after the convulsions, as internal remedies for the 
jaundiced condition, which was very pronounced, chionanthus tinct., 
20-drop doses three times daily, and for the sepsis, echinacea tinct., 
5-drop doses every three hours, keeping the bowels open with castor oil. 



It is surprising how much information can be derived by abdominal 
palpation conducted with the patient in a hot bath, the temperature of 
the water being gradually raised to 105 ° F. It usually secures as much 
relaxation as does the administration of an anesthetic, sometimes even 
more. In addition to the avoidance of the dangers and the disagreeable 
features of narcosis, it has the important advantage that the patient is 
able to call the examiner's attention to sensitive areas. — American Jour- 
nal of Surgery. 



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THE CLINIQUE. 231 

CORNEAL INJURIES. 

M. A. BARNDT, MILWAUKEE, WIS. 

It is not my intention to write a long scientific paper on corneal in- 
juries as I know that it is very hard to get the majority of physicians 
interested in this branch of medicine unless they are making a specialty 
of this subject. At a meeting of this kind it is necessary to try and 
give what is practicable to all concerned and not to the specialist alone. 

Corneal injuries are of such frequent occurrence that all present have 
more or less dealings with them, and as a rule are easily handled with 
ordinary care and attention. We might classify them as simple and 
perforating — by the simple injury I mean that form that only scratches 
or abrades the cornea or disturbs the external layer of the corneal epi- 
thelium. The perforating form is that of a more serious nature in 
which the cornea is entirely perforated and results in the escape of the 
aqueous humor and causes other internal injuries. 

In this paper I shall only refer to the very simplest form; for the 
reason that in these apparently slight injuries to the cornea we are so 
apt to neglect and overlook the danger that may arise from them and 
not realize that there is any danger until it is too late. It is a very 
simple thing to remove a cinder, a piece of emery, a chip of iron or any 
foreign body that may be imbedded in or adherent to the cornea, and 
all physicians should have on hand a small instrument for the purpose 
of removing such bodies, but after this has been accomplished do not 
let your patient go with the remark that the eye will be all right now 
and needs no further attention. Be sure to wash out the eye with some 
simple wash like boric acid or other mild antiseptic as you do not know 
what germs may have been carried into the eye by the foreign body 
and as the cornea is not abundantly supplied with blood vessels to 
nourish and protect this delicate organ, any germ of whatever nature 
may find a lodging place and after it starts to get in its work the mis- 
chief it may do cannot be estimated. 

I will mention two cases that have come under my observation re- 
cently. Mr. E., aged 28,,(a blacksmith,) on Saturday, Aug. 15, was 
chipping some rust from an iron buggy tire, when some of the rust 
flew into his eye; some of it was picked out by his fellow workman, 
and on the following morning he came to my office complaining that 
there must be some of the rust still in the eye as he could feel a scratch- 
ing and the eye felt a little irritated. On close examination I could 
not find any rust or foreign body of any kind, but saw that the outer 



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232 THE CLINIQUE. 

layer of the corneal surface had been slightly scratched and that the 
opening and closing of the lids had irritated the eye; there was no pain 
and the vision was perfect. I cleaned the eye thoroughly, advised him 
to keep the eye quiet and that usually these cases got well in twenty- 
four hours. I gave instructions to have him return in 24 hours unless 
the eye was entirely well. He did not appear until 48 hours after I 
first saw him and then the eye was bathed in pus, the entire cornea in- 
volved and nontransparent. I saw at once that the sight was lost and 
went to work to save the ball which was done after two weeks of close 
watching. 

This was a case where the young man lost the sight of his eye through 
infection carried there by the foreign body that merely scratched the 
cornea. 

Case II. Mr. R., age 38, a sawfiler by trade, tried to pry out some 
small tacks from a piece of board with a pocket knife, the last tack 
came out a little harder than the rest and flew into his eye very slightly 
pricking the cornea near the scleral border; he at once went to an op- 
tician to have the foreign body removed; the optician could not find any 
thing so told him to go home and come to him the following day if the 
eye was no better. This was on a Sunday morning and on Monday the 
eye was no better. Then the optician advised him to see an oculist, and 
he came to my office Monday forenoon. I found a slight scar or prick 
where the tack had done its work, I told him of the danger and advised 
rest, internal remedies, and cold applications and to see me the 
next day, which he did. The eye was better — treatment was continued 
and the eye was still better. On Wednesday patient wanted to go to 
work but I advised him not to for at least another day. On Thursday 
morning he was at my office very early; had pain in the eye ball, very 
severe all night; vision blurred; photophobia; considerable swelling of 
the conjunctiva and tenderness on palpation. Patient was put to bed, 
applications applied and remedies given, but the eye became rapidly 
worse, more swelling and more pain, with slight rise of temperature. 

On Sunday morning he was taken to the hospital — temperature 101° 
— severe pain in head; vision in other eye slightly blurred and occa- 
sional twitches of pain. 

Sunday afternoon no improvement being apparent, the eye was re- 
moved, just one week after the injury — thus another eye lost from a 
very slight prick of a tack. 

Many other cases could be cited, but if we can learn from these two 
cases that the utmost care is necessary in even the slightest injury to 
the cornea, in this way putting you on your guard when you have some 
of these apparently slight injuries to deal with and thus <save an eye 
will be worth many times the efforts of the writer. 



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THE CLINIQUE. 



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#xt0rial. 



Homeopathy and the Opsonin Therapy. — To us of the homeopathic 
school the theory of the opsonins and of the new vaccine therapy is so 
perfect an illustration of Hahnemann's teaching that it seems superflu- 
ous to draw the parallel. To those who are not familiar with the theory 
of the opsonins, the easiest way to understand the subject is to regard 
these newly discovered opsonins, which form part of the blood serum, 
as the cooks which prepare the germs as food for the lymphocytes to 
devour. Only in this blood-kitchen there is a different opsonin as cook 
for each kind of germ which is to be on the menu. It is exactly like 
any large restaurant which is famous for some of its dishes but where 
others are uneatable. The opsonins which prepare staphylococci and 
streptococci may be experts and the lymphocytes will grow fat on 
them, while the opsonin whose duty is to prepare the tubercle bacilli 
for digestion may do the work so badly that no self-respecting 
lymphocyte would be seen making a meal of them. In other words 
the opsonic index for tuberculosis is low, though the other indices 
may be normal. 

Unfortunately the refinement of laboratory technique is so great that 
only experts may hope to do much in this line of therapy. However 
the original method of Hahnemann, not limited to infectious diseases, 
is still open to all students of medicine. 

The vaccine used in the opsonic experiments is a sterilized culture of 
the germ whose opsonic index is to be tested. The test is first made 



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234 THE CLINIQUE. 

with normal blood and the average number of dead germs which a nor- 
mal lymphocyte can destroy is determined. If the lymphocytes in the 
blood to be tested can destroy only half as many germs then its index 
for that particular germ is only 0.5. 

Wright, of London, who has fathered the opsonin theory, believes 
that this index can be raised by injecting into the living body minute 
doses of this vaccine at intervals to be determined by the reaction after 
inoculation. The primary effect of an average dose is to depress the 
index below normal into what he calls the " negative phase." The 
secondary action then follows and the index rises above normal into 
the u positive phase," and then gradually settles to the normal like any 
other physiologic function. The larger the dose that is given, the 
greater the negative phase and the smaller the positive phase will be, 
and vice versa. With a sufficiently small dose the negative phase be- 
comes practically a negligible quantity and the more desirable positive 
phase will result before the index sinks to normal. 

Now could anything be more truly homeopathic ? The vaccine is 
similar to the original virus, but not the same inasmuch as the bacteria 
are living in the virus, and dead in the sterilized vaccine. Sometimes 
Wright uses the culture medium with the bacteria removed for his 
vaccine, and this, of course, is simply a solution of the toxines of the 
germ. Doses of these toxines given to a healthy person will produce 
temporary symptoms like those of the diseased condition but not the 
disease itself, because these bacterial diseases only exist when the bac- 
teria have an active focus within the living body. So much for the 
similar remedy. The indications are certainly homeopathic, for 
whether the toxines be injected from a laboratory culture without the 
body, or formed by the bacteria within the body, makes very little 
difference as far as the reaction is concerned except that the injected 
dose is under the control of the operator, while the bacteria will inocu- 
late more or less constantly, producing a continuous negative phase. 
The result of the inoculation in producing a negative phase of the 
opsonic index is exactly what Hahnemann referred to as the homeo- 
pathic aggravation of the symptoms. When he warned his students 
against too frequent repetition of the similarly acting drug he preceded 
Wright, who now says that it is not the quantity of the vaccine used 
but the time of application and of the repetition of the dose that pro- 
duces the good results. 

If Wright would read those sections of the Organon relating to the 
primary aggravation produced by homeo-therapeutic medication he 
would understand perfectly what Hahnemann meant. For instance > 



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THE CLINIQUE. 235 

this sentence from section 159 might have been written by either of 
these investigators: " The smaller the dose, so much the smaller and 
shorter is the apparent aggravation of the disease. " Section 280 might 
also have been written by Wright if we exclude the word home- 
opathic: "The doses of homeopathic medicine are invariably to be 
reduced so far that they will merely produce an almost imperceptible 
homeopathic aggravation." 

Welch, of Johns Hopkins, says that the three men of modern times 
who have done most to increase man's power to fight disease are Pas- 
teur, von Behring and Wright. If Wright realizes the parallelism of 
his teaching with that of Hahnemann, he should be as just as von Beh- 
ring, who wrote a year ago: " Jenner's discovery remained an erratic 
block in medicine till the biochemically-thinking Pasteur, devoid of all 
class-room knowledge, traced the origin of this therapeutic block to 
a principle which cannot be better characterized than by Hahnemann's 
word 'homeopathic.' " There is also something noble in his state- 
ment before the Berlin Physiological Society fourteen years ago when 
he said (as Wright should say now), " Gentlemen: If I had set my- 
self the task of rendering an incurable disease curable by artificial 
means, and should find that only the road of homeopathy led to my 
goal, I assure you, dogmatic considerations would never deter me from 
taking that road." G. M. mcb. 



Jamestown and the Institute. — A letter from Edward Beecher 
Hooker, M. D., president of the American Institute, informs us that 
he is soon to start out 011 a campaign to arouse interest in the forth- 
coming meeting of the American Institute at Jamestown, June 17th. 
He will speak in Boston April 10th, New York on the 11th, Philadel- 
phia the 12th, Pittsburgh the 13th, Cleveland the 17th and Chicago 
the 19th. 

This is certainly a worthy undertaking on the part of the president 
and we should do all within our power to encourage him and to help 
make good at the meeting. The American Institute of Homeopathy 
is still the bulwark in the organizations of our school and we must keep 
it in a flourishing state. A school without a national society would 
soon disintegrate and therefore this institution is of value to every prac- 
tician. Without our organization we would be left to drift in the 
world of competition without any parent help. Natural as it may be 
for a physician to think it unnecessary for him to belong to the Insti- 
tute, there may be a time when he will need not alone the protection 



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236 THE CLINIQUE. 

of that society but he may wish to point to the achievements of his 
school which are recognized only through the medium of societies and 
particularly our chief organization. Therefore both opportunity and 
duty should say to the practician at this time of the year: " I will take 
my vacation now and help on the good work by my presence and my 
support." Never in the history of our meetings have we had more to 
look for than at this gathering. Jamestown and its exposition will be 
sufficient not alone for this enjoyment on the side, but for attracting to 
this meeting the best talenfr in our profession. Therefore, make the 
resolution and the arrangement now and be with us without fail. 

The railroad rates are already announced by Dr. Forbes, chairman of 
the transportation committee, in another column, and the Big Four 
and Chesapeake & Ohio railroads are making arrangements for a 
special train to the institute. This will be the height of luxury and all 
physicians in the west who desire to go with us should send their names 
to Dr. Gilbert Fitzpatrick, No. 100 State St., Chicago, for reservations. 
As it is not an easy .matter to make these arrangements, don't fail to 
send for your reservation at once. h. v. h. 



State Charities' Demands. — The Illinois State Board of Charities 
has issued a statement calling attention to some of the needs of the 
state institutions; this letter has been presented to the chairmen of 
appropriation committees in our legislature. This totals in all more 
than seven million dollars. As a profession we are naturally interested 
and therefore the chief items are appended: 

New buildings to increase the capacity of existing institutions, re- 
move the insane from almshouses and provide more effective treatment 
for insane and other sick inmates, bringing about more cures, $772,000; 
extraordinary improvements to physical property, including improved 
fire fighting facilities, ventiliation to provide pure air for the sick, and 
devices to reduce the cost of operation, $637,380; sanitarium for con- 
sumptives to stem the ravages of disease which is causing 8,000 deaths 
annually in Illinois (including maintenance), $150,000; epileptic col- 
ony, to give more humane and less, expensive care to the sadly affected 
class and in a measure to relieve hospitals for insane (including main- 
tenance), $265,000; new asylum for the criminal insane, in place of 
the dangerous, insanitary and ill located present asylum (excess over 
maintenance), $229,600; cottages and hospitals for soldiers' wives, so 
that old couples shall not be separated in their declining years, the wife 



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THE CL1NIQUE. 237 

often going to the poorhouse, $134,686; to this add for maintenance, 
increased because of increased population and increased cost of staples 
and service, $72,000; for usual special appropriations for repairs, im- 
provements, etc., $837,250. h. v. h. 



Insurance Examination Fees. — Organized complaint is again being 
made relative to the price of insurance examination fees. The price in 
the south, in many instances, has been cut to three dollars and of 
course this has started a howl in that region. Possibly it may be said 
that some of the examinations which are made for insurance compa- 
nies are not worth any more; judging from our own experience with 
some of the present examiners in the north, even this price is too high. 
And yet the old line societies — which we patronize — still refuse to ap- 
point homeopaths because they want old school men; and we still, as a 
school, make no discrimination against the companies which knock us. 

Aside from this it is well that medical societies look into this fee ques- 
tion; insurance companies seem to afford unusually large salaries for 
their presidents who have been known to speculate with the companies' 
funds, but they do not advance the fees for physicians. Does anyone 
think for a minute that it is right for a president of an insurance com- 
pany to receive one hundred thousand dollars for his annual salary and 
then give a physician five dollars to determine the physical condi- 
tion of their applicant for insurance? Does the president earn his 
salary? And does not the examining physician earn more than his fee 
if his work is done well? In the first place a capable examiner should 
be appointed and next he should give a thorough and complete examin- 
ation which is not always done in one sitting; he should have the 
education, experience and standing which enable him to give value re- 
ceived and then by all means he should receive it. 

The insurance companies are saved annually millions of dollars by a 
careful determination of their risks; their best investment therefore is 
with the examining physician and when they pick out good ones, they 
should pay them. Lawyers employed by these same companies get 
very large fees for their services and the time is ripe for medical socie- 
ties and physicians to look out for themselves. And it is well to re- 
member that we are all policy holders. H. v. H. 



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238 THE CUNIQUE. 



THE ILLINOIS HOMEOPATHIC MEDICAL ASSOCIATION— 
SPECIAL ANNOUNCEMENT. 

Arrangements are now practically complete for the fifty-second an- 
nual session of our association, which will be held in Chicago May 14th, 
15th, 16th, and 17th, 1907. 

At a meeting of the Executive Committee held in Chicago March 
28th a letter was read from Dr. J. N. Downs, offering his resignation 
as president of the association. By vote of the committee" Dr. Downs' 
resignation was accepted, and the first vice-president, Dr. Mary E. 
Hanks was requested to assume the duties of president. Dr. Hanks 
immediately entered upon her work, and plans for the coming meeting 
Tiave gone forward without interruption. 

The first three days of the session will be at the Sherman House, 
w r here excellent accommodations have been secured, not only for the 
general meetings and committee meetings, but for the entertainment 
of individual members and their families. The Sherman House will 
l>e our headquarters during the session, and a special reduced rate is 
offered to visiting members. Physicians, who desire to take advantage 
of this rate, should write for accommodations in advance. 

The chairmen of the various bureaus are providing a scientific pro- 
gram of unusual interest which will include papers by a number of 
prominent men from outside of Illinois. leading members of our 
school will be in attendance from Minneapolis, Iowa City, Ann Arbor, 
Cleveland and other cities. 

A special item of business will be the report of the Tent Colony Com- 
mittee which has now completed its work. Sufficient stock has been 
.subscribed to insure the successful establishment of the colony and a 
regularly organized stock company has been incorporated under the 
laws of Illinois. The Buffalo Rock Farm upon the Illinois river, the 
finest location in the State for this purpose has been purchased and the 
necessary buildings will be erected without delay. A detailed report 
of this work will be presented by the chairman, Dr. Joseph P. Cobb 
and a full discussion from the members of the society is invited. 

Another matter which should receive the careful consideration of all 
our members is a proposed amendment to the by-laws which will enable 



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THE CLINIQUE. 239 

our society to co-operate with the Illinois State Medical Society in the 
physicians' defense work. The co-operation between the Chicago 
Homeopathic Medical Society and the Chicago Medical Society has 
proved so successful in protecting the members against the various 
forms of blackmail that it is proposed to give the members of both State 
societies the benefit of similar protection. A joint committee from the 
two associations now has the matter in charge and if the by-laws can be 
suitably modified at the annual meeting this arrangement will become 
immediately effective. 

The entertainment features of the meeting this year are to be along 
different lines from those which have characterized our previous meet- 
ings. The success of the clinical features introduced last year has led 
the officers to believe that it will be acceptable to the members if the 
clinical idea is made more prominent in future meetings. We are es- 
pecially fortunate, therefore, in having received an invitation from the 
Hahnemann Medical College of Chicago, to spend the entire fourth day 
of the meeting in attendance upon clinics at that institution. Acting 
in conjunction with the entertainment committee the executive com- 
mittee has decided to accept this invitation and arrange for the mem- 
bers to attend these special clinics in lieu of the formal banquet which 
has been a feature of previous meetings. Clinics will be conducted in 
general medicine, general surgery, gynecology, pediatrics, skin and 
venereal diseases, ophthalmology and otology, rhinology and laryngol- 
ogy and electro-therapeutics. The schedule has been so arranged that 
each member can attend the clinics in which he is especially interested. 
A complete program giving titles of all papers and schedule of these 
clinics will be mailed to all members some time in advance of the meet- 
ing. 

Further information regarding the details of the program may be ob- 
tained by addressing the Secretary, Burton Hazeltine, M. D., 100 State 
Street, Chicago. 



THE CHICAGO HOMEOPATHIC MEDICAL SOCIETY. 

The attention of the profession is especially called to the fact that the 
April meeting of the Chicago Homeopathic Medical Society will be held 
on Friday evening, April 19th, instead of Thursday the usual date. 
The place of meeting is also changed to the Sherman House instead of 
the Northwestern University Building where the meetings have hereto- 
fore been held. 



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240 THE CLINIQUE. 

These changes have been necessary on account of the visit to Chicago 
of Dr. Edward Beecher Hooker, president of the American Institute of 
Homeopathy, who will be the guest of the Society for that evening and 
will deliver an address upon subjects pertaining to our national organ- 
zation. 

After the regular meeting a reception will be given in the parlors of 
the Sherman House when all the members will be given an opportunity 
to meet Dr. Hooker and other visiting physicians. Invitations have 
been sent to about fifty of the leading institute members of adjoining 
States and Chicago physicians are especially urged to be present in 
honor of our guests. 

Frank Wieland, M. D., 
President Chicago Homeopathic Medical Society. 



THE NORTHWESTERN HOMEOPATHIC MEDICAL SOCIETY. 

The fifth semi-annual meeting of this flourishing society took 
place at the Nelson House, Rockford, 111., Thursday, April 4, 1907. 
The following was the order of business: 

Calling society to order by President A. Smith, M. D., Freeport, 
Illinois, at 10 o'clock a. m. 

Reading of minutes of previous meeting and transaction of regular 
business. 

Annual address by President A. E. Smith, Freeport, Illinois. 

REPORT OF BUREAUS. 

Pathology and Preventive Medicine: Chairman H. G. Davis, M. 
D., Monroe Center, 111. Eruptive Diseases, H. G. Davis, Monroe Cen- 
ter, 111. Discussion, opened by C. A. Walker, M. D., Rockford. 

Afternoon Session, 1:30 p. m. 

Eye, Ear, Nose and Throat: Chairman, Robert C. Mitchell, M. D., 
Belvidere, 111. Hypertropic Rhinitis, Robert C. Mitchell, M. D., Bel- 
videre, 111. Discussion, opened by Dr. W. R. Franklin, M. D., Rock- 
ford. 

Bacteriology, Urinology and Mechanical Therapeutics: Chairman, 
Katherine James, M. D., Rockford, 111. 

The officers of this society are: President, A. E. Smith, M. D., 
Freeport; Vice-President, F. K. Hill, M. D., Rockford; Secretary, C. 
A. Walker, M. D., Rockford; Treasurer, S. H. Hilliard, M. D., War- 
ren; Member Ex. Board, W. R. Franklin, M. D., Rockford. 



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THE CLINIQUE, 241 

THE EASTERN ILLINOIS HOMEOPATHIC SOCIETY. 

This society is still full of life and met at the court house build- 
ing, Charleston, 111., Monday, April 10, 1907, at 2:00 p. m The fol- 
lowing program was presented: 

" President's Address," W. N. Linn, M. D., Oakland, 111. 

Bureau of "Clinical Medicine," Chas. Boaz, M. D., chairman. 

44 Clinical Cases," (two by each of the following): Prof. H. V. 
Halbert, Chicago, 111.; J. J. Rose, M. D M Marshall, 111.; Chas. E. 
Greer, M. D., Charleston, 111.; R. S. Lycan, M. D., Paris, 111.; J. W. 
Welker, M. D., Mattoon, 111.; Chas. Boaz, M. D., Mattoon, 111. Dis- 
cussion. 

Bureau of "Eye, Ear, Nose and Throat," G. A. Denman, M. D., 
chairman. 

"Obscure Mastoid Cases," Burton Haseltine, M. D., Chicago, 111. 
Discussion. 

Three Cases " Penetrated Cornea," G. A. Denman, M. D., Tuscola, 
111. Discussion. 

"Selected," W. H. Lycan, M. D., Charleston, 111. Discussion. 

The officers of this society are: President, W. N. Linn, M. D.; Vice 
President, C.R. Phelps, M. D.; Treasurer, John Ewing, M. D.; Execu- 
tive Member, Wm. G. Lycan, M. D.; Secretary, W. E. Conklin, 
M. D. 



THE HOCK RIVER INSTITUTE OF HOMEOPATHY. 

This society held its eighty-ninth quarterly session, Thursday, 
April 4th, 1907, at eleven a. m. and one-thirty p. m., at the White- 
side Hotel, Morrison, Illinois. The " following program was pre- 
sented: Contagious Diseases — Scarlet Fever, Diphtheria, Small 
Pox. 1. Bacteriology and Immunity in Scarlet Fever, Diphtheria and 
Small Pox, J. L. Snavely, M. D., Sterling, 111.; Discussion, W. I Car- 
olus, M. D., Sterling, 111. 2. Quarantine, Disinfection and Differen- 
tial Diagnosis in Scarlet Fever, Diphtheria and Small Pox, F. J. Scott, 
M. D., Rock Falls, 111.; Discussion, F. C. Skinner, M. D., LeClaire, 
la. 3. Pros and Cons of Vaccination, W. O. Story, M. D., Franklin 
Grove, 111.; Discussion, O. B. Blackman, M. D., Dixon, 111. 4. 
Serum Therapy, M. J. Hill, M. D., Sterling, 111.; Discussion, B. L. 
Sears, M. D., Amboy, 111. 5. Homeopathic Therapeutics in Scarlet 
Fever, Diphtheria and Small Pox, C. Lanning, M. D., Prophetstown, 
111.; Discussion, C. N. Hazelton, Morrison, 111. 

E. A. Sickels, Pres., A. W. Blunt, Sec'y. 



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242 THE CLINIQUE. 

COMMENCEMENT ANNOUNCEMENT. 

The forty-seventh annual commencement of the Hahnemann Med- 
ical College will take place May 27th at 2:30 p. m. in the Garrick 
theater. 

Dr. Geo. L. Collie, acting president of the Beloit College, will de- 
liver the annual address to the graduating class on the subject of 
u Scientific Culture and its Relation to the Medical Profession." 



HAHNEMANN ALUMNI ASSOCIATION. 

The annual meeting of the Alumni Association will take place in the 
parlors of the Auditorium Hotel May 27th, at 7 p. m. sharp. At this 
time several important matters pertaining to the future of the associa- 
tion will be discussed. At 8:30 p. m. the annual banquet will take 
place, and it is the desire of your officers that we have a large and en- 
thusiastic audience for that occasion. Come and meet the new doctors 
who are just going out. Come and renew the acquaintance of your old 
faculty members. Come and greet your classmates, but above all come 
and have an enjoyable and jolly evening with each other. Remember 
the date May 27th at the same old place, Auditorium Hotel, Chicago. 

T. E. Costain, Secy. 



3$iscellatty* 



Treatment of Chronic Constipation. — When operations do not 
cure and when surgical procedures are unnecessary, Murray employs 
the following treatment, which is given every fourth day: The patient 
is placed in the Sims position, an electrode after the pattern of Ewald 
with a perforated rubber shield is passed into the sigmoid. The rectal 
electrode is connected from its binding post to the positive pole of the 
battery, and rubber tubing connects it also with an irrigator, filled with 
normal saline solution, which is elevated about three and a half feet 
above the patient. The rapidity of the flow of normal saline is con- 
trolled by a stop clock in the electrode. The negative electrode is made 
of sheet lead large enough to cover the abdomen, and is well padded 
with a towel wrung out of hot normal saline solution. The electric sa- 



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THE CLINIQUE. 243 

line douche washes all fecal debris and mucus from the intestinal mu- 
cosa, leaving a clean surface for medication. 

This part of the treatment occupies from ten to twelve minutes, and 
from 30 to 64 ounces of normal saline solution is thrown into the sig- 
moid and descending colon. The patient is then allowed to go to the 
toilet, where a free evacuation takes place, leaving the intestinal mucosa 
clean. After this the patient returns to the table for the last half of 
the treatment. This consists in throwing one ounce of an emulsion of 
olive oil (1 pint), iodoform (1 dram), bismuth subnitrate (2 ounces), 
into the descending colon through a Wales bougie or a special tube 
which Murray has devised. This is followed by from one to two ounces 
of some dilute astringent or antiseptic solution of hydrastis. The iodo- 
form is omitted from the emulsion if the patient has an idiosyncrasy that 
would make its use inadvisable. After throwing the medicament into 
the sigmoid, the patient is kept for about ten minutes on the table, 
which is so tipped that the hips are elevated considerably, allowing the 
emulsion to gravitate high up in the colon. 

When this treatment is begun, patients are ordered to stop the use of 
all laxatives. They are instructed to go to the toilet at a regular hour 
each day and make an honest effort to stool, taking 15 or 20 minutes, 
if necessary, using gentle pressure, but never to strain. Failing in 
this, the patient is directed to use an enema of plain water or normal 
saline in order that the bowel may be educated to empty itself at a 
regular time. While under this treatment patients are allowed liberal 
diet. Excess of pastry, confections and condiments are prohibited, 
and they are directed to drink at least six glasses of water daily. — /. 
A. M. A. G. f-p. 

Micro-organisms in Mouths and Throats of Healthy Persons. 
— All the throats examined by Rucker contained streptococci and dip- 
lococci, showing them to be normal inhabitants of the normal mouth 
. and throat. Streptococcus mucosus was found in 70 % of all cases. 
A typical pneumococcus occurred in 50 % of the 20 cases. Typical 
pneumococcus was present five times or in 25 % of the number of cases 
examined. Organisms of the same species may behave differently in 
their action on starch if the organisms are from different sources. — /. 
A. M. A. G. f-p. 

French Law Compelling Sunday Rest. — A bill has been before 
the French parliament for fifteen years and has finally been passed 
which imposes Sunday rest. Compulsory closing of shops on Sunday 
is now required, and cessation of week-day work is imperative on all 
employes or workmen in a manufacturing or commercial establishment 



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244 THE CUNIQUE. 

or its dependencies, whatever its nature, public or private, lay or cleri- 
cal, even if it has a character of professional instruction or benevolence. 
There are numerous exceptions provided for. Whenever it is evident 
that the Sunday rest for all the personnel of an establishment would be 
prejudicial to the public or would compromise the normal functioning 
of the establishment, the day of rest can be given on some other day 
than on the Sunday or divided among several days, or the personnel of 
the establishment may take turns in the Sunday rest. A special per- 
mit is necessary to have a right to these exceptional privileges of re- 
maining open all or part of Sunday, except in the case of hospitals, dis- 
pensaries, drug stores and saloons. The Semaine Medicate laments 
this special favor granted to saloons, stating that there is one saloon in 
Prance for every fifteen adult males, and their closing on Sunday would 
be a national blessing. — -J. A. M. A. 

A New Industrial Danger. — Some months ago a new kind of 
wood was introduced to replace the boxwood shuttles used in Lanca- 
shire workshops. After a few days the workmen who handled the 
shuttles began to show signs of illness and some of them died. An in- 
vestigation was undertaken by Professor Gibson, dean of the faculty of 
science in the University of Liverpool. He identified the wood as 
West African satinwood and found that it contained a considerable 
quantity of alkaloid, which, being soluble in salt solutions, would be 
readily absorbed by the perspiring skin. The alkaloid proved to be a 
powerful cardiac poison, causing rapid death when injected into the 
animals. The symptoms of poisoning in man were headache, sleep- 
iness, coryza, chronic sneezing, giddiness, faintness and dyspnea. — 
/. A. M. A. 

Carotid Tumors. — Keen and Funke present a most interesting and 
instructive article in the/. A. M. A. on the above subject, calling our 
attention to the fact that this condition is not so rare as might be 
supposed. The diagnosis rests on the following positive and negative 
facts: 

1 1 The Positive Facts. — 1. There is a tumor arising in the region of the 
bifurcation of the carotid; that is to say, about on a level with the up- 
per border of the thyroid cartilage. It lies at first under the border of 
the sternocleidomastoid, but when it has reached any size it is only 
partly covered by this muscle. 2. The tumor is moderately movable 
horizontally, but not vertically. 3. It is usually ovoidal in shape. 4. 
As a rule it is rather smooth and not lobulated. 5. It is a single tumor 
and not made up of a coalescence of several tumors, as in tuberculous 



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THE CLINIQUE. 245 

glands. 6. There is transmitted but non-expansile pulsation. 7. 
There may be bruit and thrill, but this is rare and not marked. 8. It 
may cause bulging of the wall of the pharynx. 9. The pupil is occa- 
sionally contracted. 10. It will usually grow slowly at first, and, pos- 
sibly, shortly before the surgeon sees it, more or less rapidly. 11. It 
will have existed for a number of years. 12. The consistence is neither 
very hard nor very soft, but elastic. 

The Negative Facts. — 1. There is no pain. 2. As a rule it is not 
tender. 3. There is no disturbance, as a rule, of the pneumogastric, 
either as to its cardiac or laryngeal functions. 4. There is no disturb- 
ance of the sympathetic nerve. 5. There is no change in the pupil, except 
occasionally. 6. So far as the patient is concerned, there are usually 
no subjective symptoms, but the aid of the surgeon is sought on ac- 
count of a slowly or rapidly growing deformity, and if the tumor is 
growing rapidly there may be also fear of its results.' J v. R. 

Non-Tubercular Joint Inflammations, Mechanical Treat- 
ment. — Sayre writes that in joint inflammations as rheumatoid arthri- 
tis, arthritis deformans, rheumatic gout, osteo-arthritis, malum senile 
and simple dry arthritis, whatever be the nature of the cause, there ex- 
ists one common factor namely, that they are all the seat of inflamma- 
tion. Experience has taught that rest and freedom from trauma are of 
prime importance in the reduction of inflammation, and the above joint 
inflammations offer no exception to the rule. In the author's experi- 
ence joint inflammations, whether acute or chronic, subsided far more 
readily under absolute rest than by any other means, and the danger 
of undue continuance of this measure was slight. He regards long 
continued rest as essential in these non-tubercular cases, many of 
which are chronic, as in the tubercular ones. The mechanical aids, as 
used in the latter, are applicable in these non-tubercular forms. 

Affections of the Eye in Relation to Pelvic Disorder. — 
Under the above title J. Clarence Webster, M. D., in Surgery, Gyne- 
cology and Obstetrics, reports two cases recently under his care. Inas- 
much as this subject is of such wide interest the cases are given in ab- 
stract. 

Case 1. April, 1905, a married woman of 37 years of age, whose 
complaint was "Sore eyes, pain and distress in the pelvis, leucorrhoea. 
The eyes have troubled her for eight years. At first they became red 
and sensitive, discharging freely at irregular intervals, following pain 
in the abdomen and pelvis. Latterly the intervals have become shorter. 
Occasionally at menstruation the condition of the eyes has been aggra- 



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246 THE CLINIQUE. 

vated. Five weeks before admission a corneal ulcer developed. She 
has had the eyes treated a great deal, but without any permanent 
benefit.' ' 

The examination revealed an enlarged and retroflexed uterus. 
Ovaries were cystic-enlarged-prolapsed and tender. The conjunctiva of 
each eye intensely congested and swollen with a profuse white dis- 
charge. The case was treated by vaginal panhysterectomy — within ten 
days of operation the eyes were normal and there has been no return of 
the trouble since. 

Case 2. Unmarried woman, aet 20, " Complaint, sore eyes, bleeding 
from eyes and nose, irregular menstruation, headaches, nervousness. 
Menstruation has always been irregular since it began at 13, the inter- 
vals being two weeks to six months. The duration is usually three 
days. No dysmenorrhoea. 

A year ago the eyes began to trouble her. They became red and 
tender, discharging freely, and sensitive to light. These troubles have 
recurred only when the periods have been irregular. At the time the 
flow should take place, blood escapes from the nose and eyes for a day 
or two. She menstruated last two months previous to admission. 
One month ago these phenomena occurred. Ever since they have 
troubled her considerably, and are now becoming more marked as the 
time of another period approaches. There is no pelvic pain or leucor- 
rhoea. Treatment of the eyes has been of no value. 

Condition on examination. The uterus is slightly smaller than 
normal. The left ovary is as large as a hen's egg } cystic, fixed in 
adhesions. The right ovary is somewhat enlarged and slightly cystic. 

Treatment. Abdominal section. Removal of the left diseased ovary. 
The patient left the hospital June 28, 1903, (entered May 29th). 
Within a few days of the operation the eyes became normal. On Sep- 
tember 11th returned and reported a recurrence of the eye trouble two 
weeks ago. The other ovary was removed. The eyes improved at 
once. Since that time there has never been any trouble. p. c. 

Gonorrhea in Women. — Frs. de Martigny in Jour, de Med. et 
Chir., 1906, says that gonorrhea in the female begins insidiously, so 
that during some weeks of infection the patient does not suspect it. 
Infection comes generally from connection with the husband, who be- 
lieves himself cured of the disease, and has simply a few drops of secre- 
tion left, or filaments in the urine. Some irritation, such as excessive 
intercourse or use of liquor, causes the discharge to reappear with gon- 
ococci present. If before examining a case of supposed cured gon- 
orrhea the meatus and urethra are irritated by injection of weak nitric 



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THE CLINIQUE. 247 

acid, the gonococci will reappear in the same way. In other cases the 
husband has illegitimate connection and brings the disease home and 
infects the wife. Rarely the woman infects herself by the use of pub- 
lic toilet conveniences or towels. The gonococci are kept for a long 
time shut up in the glandular structures in the male, so that the micro- 
scope does not find them. The infection does not at once reach all 
parts of the female genitals, but is frequently localized for some time in 
the glands of Bartholin. This is especially frequent in young women. 
The symptoms are heaviness and swelling of the vulva and glands, and 
appearance of pus in the orifice of the gland, surrounded by a red ma- 
cule. Fluctuation may be detected; the gland opens and leaves a fis- 
tulous opening, or the condition becomes chronic. The vagina makes 
a very bad culture medium for the gonococcus on account of the im- 
penetrable nature of the epithelium. When it is infected it becomes 
eroded at the entrance and profuse greenish pus, full of filaments, ap- 
pears. 

The epithelium of the cervix, on account of its many glands, is a 
good culture medium and is easily infected. The secretion becomes 
exaggerated and greenish, and lancinating pains occur, with swelling 
and redness of the part. The infection is always communicated to the 
lining of the uterus by continuity, and the germs enter the epithelial 
cells, and penetrate into the mucous membrane to the depths of the 
glandular cul-de-sac. Pain and purulent discharge increase and the 
next menstruation is a real hemorrhage, with fever, nausea, vomiting, 
and fainting attacks. Metritis (or salpingitis) comes on. Gonorrheal 
salpingitis and peritonitis are frequently fatal when a previous endo- 
metritis exists. In little girls in bad health, especially if they mastur- 
bate, a vulvovaginitis occurs which is not occasioned by gonococcus, 
but that is still contagious. It is the scourge of institutions where girls 
are kept, epidemics that are most intractable coming from the infection 
of many from a single case by the use of towels, thermometers and such 
instruments used in common. When the gonococcus is found it rarely 
comes from connection, but from the use of night vessel or towels. 
The vulvovaginitis of children goes through the same stages and com- 
plications as it does in the adult. Arthritis is quite common, coming 
on from one week to ten months from the time of infection. Treat- 
ment of gonorrhea consists of copious washings and douches with anti- 
septics, preferably permanganate of potash, taken lying down, with the 
bag only slightly elevated, three times a day; and tampons large 
enough to fill the vagina saturated with medicated glycerin. Bartho- 
linitis requires the opening of the glands, and their destruction by 



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248 THE CLINIQUE. 

cautery or curette. When the uterus is infected the cervix and lining 
membranes require an application of iodine or zinc after dilatation. 
When the tubes and ovaries are affected hot douches, ice applications 
to the abdomen, milk diet and suppositories of belladonna are in order. 
In chronic gonorrhea which is seen usually in the form of metritis, 
douches, astringents, and caustics to the cervix, with tincture of iodine 
to the abdomen are useful. The author estimates that 65% of salpin- 
gitis cases are due to the gonococcus, and j4 of the balance to puerperal 
infections. Another result is extrauterine pregnancy, from the destruc- 
tion of the ciliated epithelium of the tube, so that the ovum is not 
carried down into the uterus. Phlebitis is not rare, and arthritis is a 
common complication, while pleurisy and meningitis occur. Most 
women have one pregnancy and then become sterile. 

Appendicitis Larvata. — A. F. Kohn, M. D., in Surgery, Gyne- 
cology and Obstetrics, under the above title, contributes an interesting 
and instructive paper. He states that the symptoms in these cases are 
not typical of appendicitis, " there is almost never any recollection of 
an attack which is referred to the appendix. The symptoms of which 
they do complain are manifold, varying from attacks of simple indiges- 
tion to severe attacks of diarrhea. The stomach symptoms are especi- 
ally prominent in the young; attacks of belching, or pain at irregular 
intervals after eating, alternating with freedom from gastric distress of 
any kind, in spite of the most liberal diet." 

He mentions as a very, frequent symptom, attacks of cramps and 
diarrhea — or diarrhea which is painless. At times cases present all 
the symptoms of colitis, the passages consisting of hard scybala mixed 
with mucus and blood. 

Frequently the cramps are so low in the abdomen as to lead one to 
believe the pelvis the seat of the trouble. Some cases present obstinate 
constipation as the most important symptom. The author further 
states: "A point in diagnosis not clearly recorded in any of the cases I 
have gathered I have found several times as follows: For example, 
one patient complained of gastric symptoms, bloating, sense of fullness 
and weight after eating, with vomiting, especially during the menstrual 
period. Examination of the stomach contents showed slightly increased 
amount of free hydrochloric acid, otherwise chemically and mechan- 
ically negative. Bowels constipated. Loss of weight. Deep pressure 
over the stomach caused no distress; on the other hand, pressure over 
the ileocecal region at once elicited the nausea, belching and fullness 
of which the patient complained, without causing any tenderness to be 
felt over the appendix itself/ ' Removal of the appendix caused the 
subsidence of the symptoms. p. c. 



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THE CLINIQUE. 249 

Curettage in Puerperal Infection. — M. Demelin in BulL de la 
Soc. cTObste. de Paris, 1906 , says that curettage in puerperal infection 
is by no means always either necessary or advisable. There are many 
conditions that are positive contraindications to the use of the curette. 
These are phlegmasia alba dolens, uterine or periuterine phlebitis, pul- 
monary embolism, visceral complications, pelvic complications, gener- 
alized forms of infection, and prolonged infections. In all these such 
interference is too late. In other cases, more energetic treatment is 
needed, as in generalized peritonitis and uterine perforations. Other 
forms make curettage useless or dangerous, as in primitive septicemia, 
in which curettage is followed by a rapidly fatal ending. A subacute 
intoxication follows the surgical opening of the vessels, acting as ab- 
sorbing mouths. Perforation of the uterus during curettage is no im- 
aginary danger in the softened condition of the infected uterus. It may 
be followed by severe hemorrhage. The natural barriers constructed 
against absorption by cellular infiltration or leukocytic reaction are de- 
stroyed, and a raw surface is left to absorb the poison. The curette 
should never be used blindly, but directed by the finger in the uterus. 
It creates furrows in the lining of the uterus and does not evenly remove 
the surface, so that decidual fragments may remain behind. In many 
cases intrauterine antiseptic injections are quite sufficient. Forceps for 
seizing placental remains are dangerous. The author prefers to make 
a digital curettage under anesthesia, with rubber gloves. A complete 
exploration may thus be made without any danger of perforation or of 
traumatism to the organ. g. f-p. 

Involution. — Dr. Danforth says: The successful accomplishment 
of involution of the uterus during the puerperal month is absolutely 
essential to the future well-being of the mother. THe physiological 
processes involved in the return of the uterus to its normal dimensions, 
the pre-gestational state, require time for their fulfillment, and under 
the most favorable circumstances from six to eight weeks is required to 
bring about this result. Anything which retards this process, such as 
a laceration of the cervix, a mild septicaemia, or sapraemia, anaemia, 
or any of the other numerous causes of this condition, should be sought 
for and removed as soon as possible. 

These facts are well known to all of us, and yet how often do we con- 
sider our duty done when we pay a daily visit for ten days, then tell 
the patient she may sit up, and leave the case and think no more about 
it, except to send the bill. I am particular to teach students that their 
duties to their parturient patients are not by any means thus limited. 
The process of involution as marked by the gradual diminution in the 



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250 " THE CLINIQUE. 

size of the uterus should be watched carefully, and if it is retarded the 
reason should be sought and overcome at once, if possible. If due to 
some cause which cannot be removed, it should not be neglected at a 
later date. 

Patients should not be kept on the back continually at any time 
during the puerperal month; they should be encouraged to turn on the 
side freely; constipation should not be allowed; and laceration should 
be repaired. If the organ remains flabby, red lochia continues too 
long, the patient should not be allowed to get up until the congestion 
has been overcome. If a tendency to a flexion or version is discovered r 
it should be corrected at once, and a suitable support, such as a tampon 
or soft rubber support, should be introduced and worn for a time. Hot 
water daily douches to stimulate the uterus to contraction, and suitable 
medicines, such as sepia, belladonna, lilium tig., helonias and podo- 
phyllum should be given, and above all, the patient should not be left un- 
til one is assured that the vicious tendencies have been corrected. By 
so doing we are only fulfilling our duties to our patients. . g. f-p. 

Dr. Danforth, A. I. H., Atlantic City, N. J., 1906: I again repeat, 
that in cases near full term, no matter what the condition, the hand 
properly used will be all sufficient. But, I also state with equal empha- 
sis, that the obstetric surgeon will occasionally meet with cases, which 
will demand instruments to begin the dilation at least, and in a very 
few, incisions may be called for. I realize as well as any one that the 
powerful dilator of Bossi is capable of doing great harm if not carefully 
and skillfully used. It is only in an obstetrical hospital, or in the 
hands of the specialist that it is likely to be used. When the cervix is 
rigid and undilated, as it is apt to be at the 7% or the 8th month of 
pregnancy, nothing will suffice in severe cases, when immediate deliv- 
ery is necessary, but a steel dilator. The nearer full time that the case 
has proceeded, the more likely is the hand to be satisfactory and safe. 

G. F-P. 



CORRESPONDENCE. 

The following letter explains itself: 

American Institute of Homeopathy, 
Jamestown, Va., June 17-22. 

March 4, 1907. 
Dr. W. O. Forbes, Chairman Transportation Committee, No. 102 
Exchange St., Hot Springs, Ark. 
Dear Sir: Referring to your favor of 28th ulto.; beg to advise that 



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THE CLINIQUE. 251 

tickets to the Jamestown Tri-Centennial Exposition, Norfolk, Va., 
April 26-December 1, will be sold on basis of from 80 % of double the 
one-way first class fare to one first class fare plus $2.25 for the round 
trip, according to return limit, and such tickets can be purchased by 
any of your members and require no validation by you. They do, 
however, require validation by an agent of the railway lines at Norfolk. 
Pull particulars concerning fares and arrangements to the exposition 
can be obtained upon application to any ticket agent. 

Very truly, 

L. P. Farmer, Commissioner. 



gjoofc gemeurs. 



Surgery of the Genito-Urinary Organs, by J. W. S. Gouley, M. 
D., published by Rebman Company, New York. 531 pages. Cloth. 
Price $3.00 net. 

This book is of interest and value especially in that it gives a brief 
but wide historical treatment of the development of genito-urinary anat- 
omy and various surgical procedures. The author has evidently read 
widely. The work " consists of brief annotations on the nature, diag- 
nosis and treatment of some of the diseases of the genito-urinary organs 
that come within the province of surgery," and places " before the pro- 
fession the results of the writer's own researches as well as those of 
other laborers in the same field of science." The treatment in many 
cases seems somewhat obsolete, and too lacking in detail. The absence 
of illustrations is a decided disadvantage since the student often finds it 
difficult to visualize sufficiently to gain a definite picture of the various 
steps. 

The book, however, is well worth reading and owning since it gives 
so much that most books omit— detailed anatomy and pathology and a 
broad review of the development of genito-urinary work. 



Conferences on the Moral Philosophy of Medicine, prepared by 
an American Physician. Cloth, 362 pages. Price $1.50. Published by 
Rebman Company, New York. 

The reviewer was naturally disapointed, and his curiosity stimulated 
by the fact that the author modestly refrained from appending his name. 
Just why, the reviewer is unable to determine. 



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252 THE CLINIQUE. 

The book is written by one who evidently received his training some 
years ago, and was so fortunate as to have had a good literary training 
as well. His style is not that common to medical books today, and his 
many references to the older writers- and to medical history place him 
fairly well. 

The book is a guide to conduct for medical students and young physi- 
cians, and while the style is didactic and somewhat formal, the principles 
advocated might well be followed by the graduate today. 

All in all, the book is well worth a careful reading, but it is doubtful if 
the young physician today is inclined to a study of morals and ethics, 
which fact is to be regretted. 



An Epitome of Diseases of the Nose and Throat. — By J. B. 
Ferguson, M. D., of the New York Post-Graduate Medical School. 
12 mo., 243 pages, with 114 engravings. Cloth $1.00 net. Lea 
Brothers & Co., Publishers, Philadelphia and New York, 1907. 
(Lea's Series of Medical Epitomes. Edited by Victor C. Pedersen, 
M. D., New York.) 

The illustrations in this little book are as modern as most instrument 
houses can make them, that is for the armamentarium. Those devoted 
to anatomy and pathology, which are few in number, appear to have 
been borrowed from a work whose copyright has expired. The proof 
reading for the names of persons and things outside of the metropolis 
shows the usual New York exclusiveness, though we scarcely think 
that " Ingula " and " Bellanger " will feel offended, when tumors, which 
are sometimes New York products, are caricatured as " fifroma " and 
" anglioma." Such spelling may be allowed in journalism where haste 
is an essential sometimes, but never in a volume rushed into print. It 
would seem after reading this book, that all that is necessary to make a 
specialist in this line of work, is to send this volume to the " Chemist " 
to compound the abundant formulae for the office shelves, and then send 
it to the instrument maker with a check for two hundred or thereabouts 
to pay for the instruments depicted. It is somewhat surprising that a 
publishing house of the standing of Lea Brothers should risk their repu- 
tation by such a work. 



Local Treatment in Diseases of the Skin, by L. Duncan Bulk- 
ley, A. M., M. D., Physician to the New York Skin and Cancer 
Hospital, Consulting Physician to the New York Hospital, Consult- 
ing Dermatologist to the Randall's Island Hospital, to the Manhattan 



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THE CLINIQUE. 



2 53 



Eye and Ear Hospital, and to the Hospital for the Ruptured and 
Crippled, etc. 142 pages. Cloth. Price $1.00. Rebman Company, 
New York, publishers. 

This attractive little book contains a wealth of valuable information 
about local treatment in dermatology. It consists of four lectures given 
to practicing physicians at the New York Skin and Cancer Hospital in 
the spring of 1906. These lectures cover very thoroughly the various 
ingredients and forms of local applications, the modes of applying same 
and general treatment. The book is replete with valuable formula and 
ends with an unusually comprehensive index. A physician will do well 
to own a copy of this book to supplement his books on diagnosis. 



THE SPECIAL CLINICAL COURSE. 

The regular spring course of clinics will be held in Hahnemann 
College, beginning May 22d. The intention is to make this one of the 
features of the commencement week. The days will be full of clinical 
work, and will continue up to noon Monday. On Monday afternoon 
will be held the commencement exercises. On Monday at 8 o'clock 
the business meeting of the alumni will be held, and at 8 o'clock in 
the evening the annual banquet will take place. 

CLINIC SCHEDULE. 





Wednesday. 22d 


Thursday, 28d 


Friday, 24th 


Saturday, 25th 


8:30 








Surgery: 
Chislett 


9:90 


Gynecology: 


Surgery : 


Gynecology : 


Kahlke 




Blouke 


Shears 


Bailey 


Beebe 


10:30 


Strawn 


Vaughan 


Clark 


Rawson 




Hanks 


McBurney 


Flint 


Baker 


11:30 




Hunter 






2:80 


Throat and Nose: 


Skin and Venerl 


Eye and Ear: 


Medicine: 




Stearns 


Collins 


Fellows 


Halbert 




Haseltine 


Davis 


Swan 


Mitchell 




McBean 


Wieland 


George 






Lewy 




Boynton 






Street 








8:80 


Nervous Diseases 


Medicine : 


Pediatrics: 






Delamater 


Blackwood 


Cobb 


McDonald 




Wood 


Aurand 


Martin 


Hill 


4:80 


Metcalf 


Moth 
Low 
Brooks 


Fruit 

Hobson 

Fuller 





The next meeting of the Minnesota State Homeopathic InstituteVill 
be held in St. Paul,. May 21st to 23d. 



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254 THE CLINIQUE. 

NEWS ITEMS AND PERSONALS.. 

Dr. C. E. Kahlke has changed his address from 3124 Prairie Ave., 
Chicago, to 3147 Calumet Ave. 

Dr. Gordon Hamilton, of San Francisco, made a visit to Chicago on 
his return home from New York. 

Dr. Herbert H. Judd, who was interne in Cook County Hospital last 
year, has located in Fromberg, Montana. 

Hahnemann Medical College has instituted a quiz for the seniors pre- 
paratory to the state board examinations. 

Dr. G. L. Brooks has taken an office in the Reliance building, 100 
State St., Chicago. Hours one to three p. m. 

Dr. M. J. Moth has taken an office at 100 State Street, Chicago. 
Hours three to five p. m. Telephone Cent. 4639. 

Dr. J. F. Wharton has recently been appointed attending physician 
to The Chicago Nursery and Half -Orphan Asylum. 

Dr. Agnes V. Fuller, Chicago, has been appointed for the fourth 
time physician to the Chicago Home for the Friendless. 

The Jamestown Exposition and the American Institute of Home- 
opathy meet this year in the same city, Norfolk, Va., which can best 
be reached over the Chesapeake & Ohio Railroad. 

Dr. Albert M. Warner died at Waukesha, Wis., March 15, 1906, 
aged 91. He was the oldest practicing homeopathic physician in the 
middle west, and was held in high esteem by his colleagues. 

Dr. Florence N. Ward and her daughter, who have been traveling 
abroad and spending the winter in New York attending the clinics, 
made a short visit in Chicago on returning to her home in San Fran- 
cisco. 

The forty-first annual session of the Indiana Institute of Homeopathy 
will be held in Indianapolis, Ind., May 22 and 23. Dr. Samuel Har- 
well, of Noblesville, Ind., is president and Dr. W. R. Stewart, of Indi- 
anapolis, is secretary. 

Dr. Edward Beecher Hooker, president of the American Institute of 
Homeopathy, will start on a lecture tour in the interest of homeopathy 
and the institute April 10. He will be in Chicago April 19* Be sure 
and take notice of this. 

Make reservations on the special train for the American Institute of 
Homeopathy via Chesapeake & Ohio Railroads at their offices in Chi- 
cago at the earliest date possible, or address Dr. Gilbert FitzPatrick, 
100 State St., who has charge of the arrangements. 



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THE CLINIQUE. 255 

Dr. Samuel P. McKinney, formerly of this city but now of Los An- 
geles, paid his home city a recent visit. He has gone to New York for 
special study. 

There is a good location for a recent graduate in western New York 
— one preferred who can do some surgery. Address Dr. Geo. W. Sey- 
mour, Westfield, N. Y. 

The Homeopathic Medical Society of the State of Wisconsin will 
meet at Madison, Wisconsin, May 22 and 23. The chairman reports 
an excellent program. Dr. A. L. Burdick, Janesville, Wis., is sec- 
retary. 

Isabella Beecher Hooker, the mother of Edward Beecher Hooker, of 
Hartford, Conn., the president of the American Institute, died recently 
in her 85th year. She was the youngest daughter of Lyman Beecher, 
and portrayed the ability of that family in her active life. 

Dr. Pemberton Dudley, ex-president of the American Institute and 
a very prominent man in the homeopathic profession, died in Philadel- 
phia March 26th at the age of 70. Dr. Dudley was a very earnest pro- 
fessional man and had a host of friends in the profession. 

Don't forget the 63rd annual meeting American Institute of Homeo- 
pathy at the Jamestown Exposition June 17-22, 1907. See advertise- 
ment for rates or apply to Allen M. Nye, Northwestern Passenger 
Agent Big Four and C. & O. Ry's, 238 Clark St., Chicago. 

Special arrangements are being made with the Big Four and C. & O. 
R. R. for a special train to the American Institute at Jamestown, Va., 
this coming June, leaving Chicago late in the afternoon in order that 
the mountain scenery of Kentucky and Virginia may be enjoyed by 
daylight. 

Officers elected in the recent meeting of the Northwestern Homeop- 
athic Medical Society at Rockford, 111., are as follows: President, Dr. 
F. K. Hill, Rockford; Vice Pres., Dr. R. C. Mitchell, Belvedere; Sec- 
retary, Dr. C. A. Walker, Rockford; Treasurer, Dr. H. H. Hilliard, 
Warren. 

Dr. A. H. Waterman, having resigned his interneship at the Metr°- 
politan Hospital, made a flying visit to Chicago before going to Edin- 
burg, Scotland, where he will be engaged in pursuing his professional 
studies, at the same time acting as house physician in one of the local 
hospitals. 

Drs. J. P. Cobb, C. E. Kahlke, H. V. Halbert, C. G. Fellows, and 
Frank Wieland have been appointed to the staff of the Chicago 



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256 THE CLINIQUE. 

Baptist hospital. These appointments were received as a surprise to 
the appointees and were the result of a determination on the part of the 
trustees to have the homeopathic school represented. 

Dr. Elliott I. Osgood of Chu-Cheo, China, is spending several weeks 
in Chicago attending medical and surgical clinics. Dr. Osgood is a 
graduate of the Cleveland Homeopathic Medical College and has spent 
several years in medical charge of missions in various parts of China. 
After the completion of his clinical course he will return and continue 
the work. 

The annual reunion and banquet of the New York Homeopathic 
Medical College and Hospital is to take place on the evening of May 
16, at the Waldorf Astoria, New York. Dr. Chas. Francis Adams, 
president, and Dr. L. L. Danforth, toastmaster, together with an active 
board of directors, are arranging an especially fine program. The 
Association now numbers over seven hundred members and expects 
nearly that number to attend the Annual Alumni Day exercises at the 
college May 16, and the banquet the evening of the same day. J. Wil- 
ford Allen, '95, Corres. Sec. 

TEXAS NEWS. 

Dear Doctor : Please inform your readers in the news items of the 
next issue of theCLiNiQUE that the Homeopathic Examining and Regis- 
tering Board of Texas is being legislated out of existence, and will soon 
cease its functions. 

But in Texas are perhaps 100 towns of 1,000 to 6,000 population 
with no homeopathic doctors, and we want a man — a good homeopathic 
physician and surgeon, in each one, before the bars are put up. 

This board, under the present law can register without examination, 
qualified physicians (of any school of practice), holding state certifi- 
cates of Illinois, Iowa, Ohio, New York, Missouri and other up-to-date 
states. Those who may have any idea of ever locating in this great 
and growing state should register at once, before the homeopathic board 
is abolished, and a mixed board with more stringent requirements is 
established. The new law will go into effect in a few weeks. 

Applicants should act at once. See present law in late medical 
directories. 

H. B. Stiles, M. D., 
Sec'y Board of Homeopathic Medical Examiners, Waco, Texas. 

March 7, 1907. 



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THE CLINIQUE. 



VOL. XX VII I, MAY, 1907. NO. 5 



Original ^rticLes. 



THE ARTIFICIAL FEEDING OF INFANTS.* 

HARVEY B. DALE, M. D., OSHKOSH, WIS. 

The bottle-fed baby is ever with us. In this strenuous twentieth 
century the exigencies of mundane existence seem to be gradually 
forcing the human mammary gland into a state of harmless uselessness. 
Consequently, the problem of what to do with these unfortunate young- 
sters is constantly becoming more serious. A good start in life is of 
vital importance to the baby. It is not enough that he should eke out 
a miserable existence on any old thing that his well-meaning, but 
ignorant mother may choose to feed him. Neither is it all-sufficient 
that he should become so round and so plump as to be pictured on calen- 
dars as a shining example of the possibilities of some patent baby food. 
As a rule, it is not very hard to fatten a baby. Not every fat baby is a 
healthy baby, however, by any means. The grim specters of rickets 
and of scurvy may be lurking in the background, awaiting the favor- 
able moment for laying their gaunt fingers on the little victim. Nat- 
urally, the specters in question are not portrayed on the aforementioned 
calendars, nor are they descanted on by the man behind the food. 
Great is the maker of the modern baby food, and the careless physician 
is his prophet! 

There is no room for dispute over the proposition that the mother's 
milk, other things being equal, is the best food for any baby. Neither 
is there likely to be any argument, among intelligent students of the 
problem, over the statement that cow's milk, when maternal milk can- 
not be had, is the best substitute that is available. To be sure, cow's 
milk was intended for calves, not for babies, and there are certain im- 
portant differences between the human and the bovine product, but 
these differences can be overcome to an extent, and the cow's milk can 
♦Read before the Oshkosh Medical Club. 



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258 THE CLINIQUE. 

be made fairly satisfactory to the average human infant. Often this is 
not so simple a problem as it would seem, however, and there are cases 
in the practice of every pediatrist which will tax his ingenuity and his 
resourcefulness to the utmost. Of course, grandma knows, because she 
has brought up divers and sundry babies, that all that any infant needs 
is a simple mixture of cow's milk and water. There are babies and 
babies, however, just as there are digestive systems and digestive sys- 
tems, and no light is thrown on the digestive capacity of the average 
twentieth century infant by the fact that grandma's progeny may have 
been able to assimilate boiled carpet-tacks. 

In attempting to make cow's milk a substitute for mother's milk, 
the question must be approached from two viewpoints, the chemical 
and the physiological. Of the two, the latter is the more important. 
It was formerly considered sufficient to make the two fluids chemically 
identical, but in practice this has proven to be a serious mistake. Nor 
is it any wonder that chemistry has failed, miserably. A mixture of 
raw beef, beef suet, sugar, salts and water can be made chemically 
identical with mother's milk — but who would be guilty of feeding such 
a mess to a baby ? It is evident that the baby's food must be a mixture 
which will contain the various elements necessary to nutrition and to 
growth. This is not all, however, for those elements must also be in 
such form as to behave, in the baby's alimentary tract, as nearly as 
possible like the maternal milk which belongs there. They must be 
in a condition which will permit of ready absorption and assimilation. 
If they are not, they will be wholly useless, if not actually injurious. 
Here is where the greatest difficulty arises, in feeding a baby. There 
is a vast difference, physiologically speaking, between a calf and a 
human infant, and there is just as big a difference, from the same point 
of view, between cow's milk and mother's milk. 

The proteid in cow's milk, like the proteid in mother's milk, con- 
tains two principal constituents, casein and albumin. The former is 
precipitated in the stomach, the latter passes through the pylorus in 
solution. The casein in mother's milk is thrown down in a light, floc- 
culent cloud, that in cow's milk precipitates in the form of a dense, 
tough curd. Physiology readily explains this, for the calf's stomach 
constitutes eighty per cent of the whole digestive apparatus, and the 
casein is intended to remain there for a long time. In the human in- 
fant, however, the stomach is but twenty per cent of the digestive tract, 
the major portion of digestion being carried on in the intestines, and 
the casein is intended to pass through the pylorus very soon after it has 
been precipitated. On account of its density and firmness, the casein 



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THE CLINIQUE. 259 

In cow's milk will not do this, and this explains why baby vomits curds 
when he takes his cow's milk unmodified. Adding water to the milk 
relieves the situation to a very limited extent, if at all, for the water in 
no way affects the tendency of the casein to precipitate in a coarse, 
dense mass, and if added in large quantities it dilutes the food to such 
an extent that it is necessary for the baby to overwork his digestive 
apparatus, trying to get enough nourishment to sustain life. Cow's 
milk needs a diluent, most assuredly, but that diluent should be some- 
thing more than water. 

On this question of diluents there are still some wide differences of 
opinion among conscientious and painstaking pediatrists. It was long 
since learned that cereal gruels will so modify the casein in cow's milk 
as to cause it to precipitate in a comparatively light and flocculent form. 
Jacobi has advocated their use, for years. Chapin recommends the 
cereal gruels, especially when dextrinized, even ill the earliest days of 
infancy. Cotton mentions them favorably, in his recent work. Fischer 
commends their intelligent use. On the other hand, Holt inclines to 
the opinion that farinaceous gruels are usually of doubtful value, if not 
actually injurious, before the seventh month. Winters, in a copyright- 
ed pamphlet on infant feeding which has recently been scattered broad- 
cast, mentions cereals only to condemn them. He characterizes the 
mere idea of their use as * 'eminent of puerility," and declares that even 
to endorse their employment is "most preposterous, most deplor- 
able." He advances the old argument that there is no warrant in na- 
ture for the administration of farinaceous food before the sixth month. 
The best answer to this is Chapin's remark that nowhere in nature do we 
find a human breast secreting cow's milk. Artificial feeding is but a 
makeshift at best, and there is no more reason in condemning the cere- 
als, intelligently used, than there is in condemning the cow's milk, 
-which is admitted by every pediatrist to be a sine qua non. 

My personal opinion is that the cereal gruels are of great value in 
feeding babies even in the earliest weeks of infancy, and I should dis- 
like to be compelled to handle a bottle-fed baby without using them. 
Not only does the cereal gruel act as a diluent, with a modifying action 
on the troublesome casein, but it also furnishes a certain amount of 
proteid in a form in which the infantile digestive tract can absorb and 
assimilate it. The latter is especially true when the gruel has been 
dextrinized. Dextrinizing thins the gruel, converting gelatinous 
starch into soluble starch, and later into dextrin and maltose. The re- 
sulting fluid is more digestible than before the diastase has been added. 
To be sure, the proteid in a gruel is vegetable proteid, but there is every 



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260 THE CLIN1QUE. 

evidence that it is assimilated by the human infant, and for that mat- 
ter its use is just as logical as the proteid in cow's milk. 

Lime-water has long been one of the orthodox ingredients in the 
food of every bottle-fed baby. It was originally used, on the theory that 
cow's milk is acid, while maternal milk is alkaline, and the resulting 
deduction that something must be added to neutralize this unnatural 
acidity. That lime-water aids in the digestion of cow's milk there can 
be no doubt, but its use seems to have been " more of a hit than any good 
wit " on the part of the medical profession, for more recent investiga- 
tions have shown that cow's milk is not acid, in the ordinary acceptance 
of that term. Further investigations have also shown that the real 
value in the lime-water lies in its ability to modify the precipitation of 
casein, in which respect it resembles the cereal gruels. Various other al- 
kaline liquids are said to have a similar effect, but this has been disputed. 
Winters claims that lime-water is an " ally to the motor function of the 
stomach in its passage of proteid through the constricted pylorus," and 
he adds that ' ' magnesia and soda for this facility are profitless. ' ' Some 
recent writers have advocated the use of citrate of sodium as a casein 
modifier. Cotton speaks favorably of it, and calls attention to the fact 
that it is simple and easily used, a point of some value in dealing with 
the average mother, to whom the whole matter of milk modification is 
a good deal of a Chinese puzzle. I have used the sodium citrate several 
times, but with only indifferent success. 

Leaving out this problem of casein modification, the proper adjust- 
ment of cow's milk along other lines is a comparatively easy matter. 
The percentage of carbohydrates is larger in mother's than in cow's 
milk, but the proper proportion is readily reached by adding sugar to 
the latter. Most authorities prefer milk sugar to cane sugar for this 
purpose, but Jacobi argues strenuously from the opposite direction. 
He bases his argument on the fact that milk sugar is very readily de- 
composed, with the formation of lactic acid, thus souring the milk. 
Cane sugar is much more stable. As a matter of fact, in actual prac- 
tice it probably makes very little difference which sugar is used, for 
both have their disadvantages. Although cane sugar is the more stable, 
it certainly seems to have a tendency to ferment in the digestive tract, 
with a consequent formation of gas, which may prove very trouble- 
some. While either one of the sugars will give reasonably good satis- 
faction, neither is perfect. 

With these few general considerations in mind, we are able to ap- 
proach the great problem of feeding babies, and to get at the matter in- 
telligently. Given an infatft deprived of the proper maternal suste- 



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THE CLINIQUE. 261 

nance, what are we gbing to do about it, and how shall we go to work 
to do it? To begin with, we can control the physiological behavior of 
the casein in cow's milk by using cereal gruels, or lime-water, or both. 
This will solve the problem of diluents, in the most satisfactory way 
that is known at the present writing. The chemical aspect of the ques- 
tion next confronts us, and in dealing with this phase of the situation 
there is no doubt that the percentage, or so-called American system of 
milk modification is the most rational and the most satisfactory method 
that has ever been devised. It has its drawbacks, however, not so 
much on the theoretical as on the practical side. Rotch advises the 
pediatrist so to school himself that he can " think in percentages." 
Holt lays out a very elaborate table of figures, and if the physician 
wants to think along that line he will certainly find abundant food for 
thought in Holt's writings. 

Their complexity is the great obstacle to the general use of Holt's 
tables. The average practitioner will not find it easy to master them, 
and, even if he does, he will strike a great many snags when he tries 
to make the average mother carry out his ideas. Elaborate directions 
must be given, these will have to be reduced to writing to ensure accu- 
racy, and even after all this trouble there is more than an even chance 
that the weary mother will grow careless and make a mess of the whole 
thing. Complex formulae can be used in hospital practice, but in gen- 
eral outside work they are likely to prove more of a nuisance than a 
benefit. Many of the mothers whom we all meet are not any too in- 
telligent, and many of those who are intelligent will not bother them- 
selves to carry out an elaborate and formidable looking set of directions. 

A few years ago I had an opportunity to make what promised to be 
a most satisfactory test of Holt's methods, carried out in every detail. 
The mother, who had to wean her baby at the age of a few weeks, took 
a deep interest in the matter, was anxious to be accurate, and even se- 
cured the services of a trained nurse for an indefinite period, with an 
idea of looking after the minutest details. There was some trouble 
in getting this baby started just right, and for three or four weeks it 
was necessary to do a little adjusting. This the mother did cheerfully, 
and she soon had the whole technique at her finger-ends. Just as 
things were beginning to go smoothly, however, the baby's grand- 
mother came for a visit. She looked into the situation, sniffed a mighty 
sniff at what she called a 4C lot of fol-de-rol," finally threw the whole 
elaborate scheme overboard, discharged the nurse, dismissed the doctor, 
and put the baby on a well-known patent baby food. The baby lived 
and apparently thrived, and after thinking the whole matter over I 
concluded that this experience was not without its moral. 



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262 THE CLINIQUE. 

If not Holt, what then? Shall we fly to the arms of the baby food 
maker, endorse his extravagant claims for the merits of his particular 
compound, and make use of his brains in treating our babies ? Hardly. 
T t is perfectly evident, however, that simplicity and ease in preparation 
are two points in the baby foods that appeal strongly to the average 
mother, and that in order to compete with this purveyor of pap we must 
meet him on his own ground. The simpler that a baby's food can 
be made, the better for all parties concerned. Personally, I prefer 
Chapin's method, which is simpler than Holt's. Chapin uses either 
nine-ounce or sixteen-ounce top milk, according to the age and require- 
ments of the infant, adding thereto a simple diluent, preferably dextrin- 
ized barley gruel, or oat-meal gruel, or rice gruel. In the nine-ounce 
top milk the ratio of fat to proteid is 3:1, and in the sixteen-ounce top 
milk it is 2:1. The actual amount of fat in cream or in top milk, on 
which Holt lays great stress, is immaterial; in fact, it cannot be accur- 
ately estimated in any milk, on account of decided variations in the 
same milk from day to day. The ratio of fat to proteid will be found 
to be about the same, however, in either rich or poor milk, and it is this 
ratio which is of importance to the baby. Young infants need the 
high ratio, 3:1, older ones will thrive on 2:1. Young babies need a 
very large amount of fat, proportionately. Winters especially empha- 
sizes this point; in fact, the whole burden of his song is fat, and then 
more fat. He even goes so far as to assert that the so-called fat diar- 
rhoea referred to by other pediatrists is entirely a delusion. 

What of the divers and sundry patent baby foods ? Shall we con- 
demn them entirely ? If we undertake to do this, we are sure to run 
counter to numerous mothers who have raised this and that baby on so- 
and-so, and who will flatly refuse to believe what the doctor tells them. 
As a matter of fact, some of these foods are not without merit. Laying 
aside the matter of expense in their continual use — an item which has 
to be considered by many mothers — and rejecting the absurd claims of 
their promoters that they are " perfect substitutes for breast-milk," we 
must admit that some of them are valuable as diluents. The one great 
objection to all these foods is that they contain an excess of carbohy- 
drates and are deficient in fat. Those which are to be prepared by 
simply adding water contain almost no fat at all. Those which are to be 
mixed with fresh cow's milk are the least objectionable. There is no 
getting around the fact that the fresh milk is a sine qua non. No 
laboratory compound of any kind can take its place, even though that 
compound be such that when diluted with water or otherwise manipu- 
lated it will chemically resemble mother's milk. 



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THE CLINIQUE. 263 

Personally, I prefer Mellin's food, if I have to use any of them. 
According to its makers, who presumably tell the truth, this food is a 
11 soluble, dry extract from wheat and malt, consisting of maltose, dex- 
trine, proteids, and soluble phosphatic salts." It will be noted at a 
glance that when water is added to this it becomes nothing more nor 
less than a dextrinized cereal gruel. As such, it is a valuable diluent, 
and when rightly used it may prove very satisfactory. To pronounce 
it, however, as its makers unblushingly do, u the only perfect substi- 
tute for mother's milk," is sheer nonsense. It is a cereal diluent, 
nothing more nor less. More than that, when it is used, nine-ounce 
or sixteen-ounce top milk, as required, should be mixed with it, in- 
stead of a certain quantity of " fresh milk," as specified in the direc- 
tions. What is meant by u fresh milk " is rather indefinite, but pre- 
sumably it means milk containing all its cream, used before the latter 
has had time to rise. It is very evident that such a mixture will be 
decidedly deficient in fat, proportionately speaking, especially in the 
case of the very young infant. This can be remedied, however, by- 
using the nine-ounce top milk, and after this is done there are only 
two objections to Mellin's food — its cost, and the fact that the propor- 
tion of carbohydrates in a mixture of it is rather excessive. Carbohy- 
drates make babies fat, to be sure, but, as I have mentioned before, the 
fat baby is not necessarily a healthy baby. 

This broad problem of baby feeding might be discussed almost indefi- 
nitely. I want to say just one thing more, however, before closing 
this paper, and that is that the successful pediatrist will not try to fit 
the baby to the food, but rather the food to the baby. Starting a baby 
on any artificial food is always more or less of an experiment. No two 
babies are alike, and what one will digest another may not be able to 
tolerate. There is only one way to find out what will agree with a 
given baby, and that is to try, and if necessary try again and again. 
Beautiful theories are often demolished, too, in the course of this test- 
ing process. Again, "make haste slowly," ought to be every pedia- 
trist's motto. Sudden, radical changes in feeding are always danger- 
ous. Having found the proper food for the baby under treatment, 
using it weak at first, increase the % strength of it very gradually. A 
baby's digestive apparatus is elastic when it is not worked too hard at 
the start, and in a comparatively short period of time the desired food 
can be reached, but trying to rush matters in the beginning has put 
many an infantile digestive apparatus into a demoralized condition 
from which it required weeks or months to recover. I believe that no 
one field of professional endeavor requires more study and more 



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264 THE CLINIQUE. 

patience than that of caring for the bottle-fed baby. Some infants 
have a surprising amount of vitality, to be sure, and these will stand 
almost anything; but there is a multitude of others whose little lives 
may be extinguished like the snuffing out of a candle. The latter class 
offer the pediatrist an ever-present problem. They must be handled 
with extreme care. They can not be brought up by any fixed rules, 
and they cannot all be saved by any commercial baby food, the pur- 
veyor of patent pap to the contrary, notwithstanding. 



PULSATILLA IN GASTRIC DISEASES. 

H. V. H ALBERT, M. D., CHICAGO. 

In our effort to correct functional disorders of the stomach we are in- 
clined to seek the dietetic means only; this of course is a natural and 
many times a safe procedure, but it is rarely sufficient to cure a gastric 
perversion of long standing. In chronic gastritis the derangement of 
gastric secretion is usually of too long standing to affect the normal 
condition by the simple dietetic correction alone, necessary though this 
may be. We are therefore not alone obliged to seek and remove the 
irritating cause, but to employ as far as possible the affiliated remedy; 
this in turn is to be used with a similar dependency upon the dietetic 
corrections and other adjuvant necessities which are now recognized as 
essential in our therapeutic procedure. In other words we are to use 
every scientific discovery which is valuable in the treatment of disease, 
but wemust not forget our remedy. 

This is surely an age of specialties in which it is not improbable that 
surgery is overlapping medical therapeutics. A large class of practi- 
cians, who are inclined to surgery or other specialties, are prone to be- 
lieve and often give expression to the belief that there is not much in 
medicine; and as a result many of the laity are disposed to feel that 
medicine is of little account after all; hence the tendency to take med- 
icine is decreasing all the time. Unfortunately this applies too fre- 
quently in the clientage of practicians in our school and we are obliged 
to suffer as a result of the reaction from overdosing in the old school 
and underdosing in our own. The specific in medicine is constantly 
sought and people are bound to have it if possible; thus it is now our 
opportunity to demonstrate that our method or our aim is to furnish a 
specific remedy which is prescribed in small dosage through the aid of 
a specific law; that this law, subject of course to limitations and excep- 



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THE CLINIQUE. 265 

tions, pertains to the affiliation of the physiologic action of remedies 
and the symptoms of disease; that moreover it is not to be dissociated 
with other scientific procedures or anything which aids recovery from 
diseased conditions. In other words we are to treat the sick according 
to our best judgment and to attain our results by the most scientific 
methods, but we shall probably never succeed independent of remedies. 
Therefore it seems as if this age is particularly tolerant and more than 
willing to listen to the claim of the homeopathic system providing we 
discard absurd and untenable claims. 

Pulsatilla, in the treatment of chronic gastritis, is in no sense inimi- 
cal to dietetic and adjuvant treatment, but it is likewise more essential 
when it is indicated. In the first place we naturally affiliate this rem- 
edy in cases where the mental symptoms are marked; hence it has been 
erroneously applied to women of gentle and yielding dispositions, 
blonde-haired, tearful and prone to sedentary life or social extremes. 
This is apparently a mistake, and by all means an extreme differentia- 
tion; the color of the hair and the disposition are not of so much con- 
cern as the acquisition, the result of disease, of a mental or irritable per- 
version which goes hand in hand with the sickness; while the normal 
temperament deserves diagnostic consideration, it is not to be compared 
with the mental symptoms of Pulsatilla which pertain to the morbid 
condition. Who has not observed the mental condition of dyspeptics, 
male as well as female, and who has failed to define this morbidity as a 
feature of the gastric perversion? Cure the indigestion and it surely 
disappears and hence it is not right to ascribe this phenomenon to the 
Pulsatilla patient, but to the dyspeptic state which creates the Pulsatilla 
symptoms. When a man, woman or child is unable to take a normal 
food into the stomach and digest it these morbid mental symptoms soon 
develop and no wonder the patient weeps easily, becomes timid, irreso- 
lute and melancholic. A similar mental state exists in the hydrastis 
condition when the patient is not alone depressed but seems to like it 
for death is often feared. Kali bichromicum another similar remedy, 
does not present the same mental extreme for here the cephalalgic 
symptoms pertain more to the real headache which is associated with 
stomach disorders. 

The most characteristic symptoms of Pulsatilla relate directly to the 
stomach, and hence it is primarily a gastric remedy. We have been 
accustomed to find the cardinal suggestions in the aversion to fat food, 
eructations, heartburn and other dyspeptic signs. While these are cer- 
tainly guiding symptoms we must look for the underlying meaning. 
Pulsatilla is naturally indicated in a catarrhal gastritis wherein organic 



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266 THE CLINIQUE. 

acids are present; under such a state it is not alone natural for a patient 
to dislike fatty or greasy foods, but, on account of the improper diges- 
tion, to be disinclined to take any food; thus while fats are repulsive 
no food is particularly agreeable or well digested. The demand made 
of Pulsatilla is to remove the catarrhal cause, the perversion of gastric 
secretion and likewise to stimulate a normal peristalsis. How is this 
done? Well, it is done first of all because pulsatilla has a natural affin- 
ity for delicate glandular structures as, for instance, we find it very 
efficacious in inflammatory involvement of the ovaries and the prostate; 
it has a similar affinity for the gastric glands as it tends not alone to 
overcome an inflammatory state, but it helps a normal secretion. This 
is a feature of pulsatilla which we have too often overlooked. Often in 
the extreme cases where pulsatilla is indicated nux vomica or bryonia 
may be needed as primary or adjuvant remedies to restore or rejuven- • 
ate an impaired peristalsis and secretion which pulsatilla alone cannot 
correct. Sometimes it is best to add or first prescribe a dilute hydro- 
chloric acid to aid the albumen digestion, but these remedies will not 
cure the case without the aid of pulsatilla if it is truly indicated. 

It should be remembered that, in the pulsatilla case, all mucous 
membranes are usually affected and for that reason we notice the coryza 
with its mucous discharge, the dry cough in the evening, with the thick 
greenish expectoration, the profuse lachrymation with the agglutination 
of the eyelids from the mucous secretion, the occasional otorrhea and 
the more rare cystic catarrh. Notwithstanding all these symptoms the 
extreme of the catarrhal symptoms are gastric; hence the yellow white 
coating on the tongue is expressive of a similar gastric coating. This 
condition explains the aversion to food, particularly the rich and fat, 
and to a certain extent accounts for the lack of thirst ; in hyperchlor- 
hydria and the more acute gastric involvements thirst is pronounced 
and water is agreeable. For the same reason gastric distress after eat- 
ing, heartburn, eructations and the prolonged dyspepsia follow as the 
result of a faulty proteid digestion. The painful and distended condi- 
tion of the abdomen, the occasional colic and the other signs of intes- 
tinal catarrh are coexisting indications of the widespread mucous 
membrane involvement. We may add to these symptoms many others 
which suggest a similar hepatic involvement and for this reason we may 
appreciate the fact that pulsatilla pertains to a widespread mucous per- 
version. It is by no means to be inferred that pulsatilla will alone 
always accomplish all that is necessary in the treatment of this diseased 
state, but it is to be expected that these symptoms are only removed by 
Pulsatilla and the diseased condition is only cured permanently by the 



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THE CLINIQUE. 267 

aid of this remedy. It is possible when the liver is extremely inactive 
and the intestinal digestion is decidedly impaired that we shall need the 
temporary help of a more hepatic remedy. At the same time we shall 
be obliged to come back to Pulsatilla for a complete cure. 

We make a' great mistake when we treat gastric diseases with no 
thought for intestinal perversions; this is doubly true when we make 
this error in treating the Pulsatilla case. The gastric catarrh naturally 
permits the introduction of a faulty product into the intestine and the 
coexisting intestinal catarrh also aids the impairment of intestinal di- 
gestion; hence the many attending intestinal symptoms; for this rea- 
son no two stools are alike, the mucous and bloody discharges, the ab- 
dominal pain and the hemorrhoids, the urticarial itching and similar 
signs of intestinal impairment are in evidence. This also explains why 
such complimentary remedies as kali mur, lycopodium, silicea and 
magnesia phos. are often needed at times. It also explains why indi- 
can is found in the urine of a Pulsatilla patient. 

From this cursory resume we may learn that it is impossible to un- 
derstand and make use of the cardinal symptoms of a remedy in the 
treatment of a disease; at the same time it may explain to us the mean- 
ing and the relationship of associate symptoms. Any other applica- 
tion of a remedy will be unsatisfactory. Above all I hope this abbrevi- 
ated thesis may call attention to a remedy which is too infrequently 
used in the treatment of alimentary diseases. 

Our materia medica tells us that Pulsatilla may be used in any po- 
tency from the third decimal to the thirtieth or higher potency. Just 
why this limitation is made is beyond my understanding. I believe it 
is a stereotyped statement that has become fixed in our literature with- 
out a sufficient explanation of the reason. I further believe that the 
question of potency has no direct relation to the use of the remedy. In 
saying this I do not deny the possible efficacy of potency but some bet- 
ter reason than an established belief must be given. In my experience 
better results have been obtained from the use of five to ten drop doses 
of the tincture, well diluted with water, four to six times daily. And 
I further believe that, in the average case, the remedy should be given 
for some time. 



Do not be too sure that a mass in the region of the pylorus is a carci- 
noma. In some cases the infiltration around a chronic ulcer is very ex- 
tensive and may simulate the feel of a new growth. — American Journal 
of Surgery. 



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268 THE CLINIQUE. 

NOT AN UNCOMMON OCCURRENCE. 

G. F. ADAMS, M. D., KENOSHA, WIS. 

Narrative. — On the morning of November 16th, 1906, Mr. A., a 
prosperous business man, left his home to go to his office in the 
city of Chicago. Apparently, so far as his family observed, he was 
as well as usual when he left his house after breakfast. He read the 
morning paper on the way into the city, and arrived at his office at the 
usual time. As he entered his office he attempted to speak, and then 
for the first time found that he was unable to articulate correctly, 
although he knew perfectly well what he wanted to say. 

It is needless to state that he was very mnch frightened. Without 
attempting to call attention especially to his trouble, he hurried to a 
near-by drug store for some medicine, and was there unable to make 
himself understood. The druggist recognized him, and realizing that 
something was wrong, accompanied the unfortunate man back to his 
office. A brother, who was present, immediately called a physician, 
and the patient was taken to a hospital. He remained there under 
treatment until December 2d, when he had so far recovered that it was 
deemed advisable for him to return to his own home. Mr. A. visited 
his office a number of times, but did not plunge into business very 
deeply, and early in January left for the east. There he had an in- 
terview, made a provisional contract for some df his manufactured 
goods, wrote a correct report of the business transaction to his office, 
visited a member of his family in a near-by city, and then continued 
on to the south, with the idea of taking a prolonged and much needed 
rest. He entered 'into the life of loafing as naturally as any active 
business man possibly could. Apparently, so far as his wife could 
judge, he was quite himself until January 10th, 1907, when he was 
again found in a confused state, and so continued until he had several 
convulsions. 

He subsequently began to improve, and while not very clear men- 
tally, was able to return home February 5th. Upon his arrival home 
he became very restless, and was taken to a nearby sanitarium. Four 
days later I visited him there, and he accompanied me to the Pennoyer 
Sanitarium, at Kenosha. While on the train he was much confused, 
unable to carry on any conversation, and, in fact, unable to articulate 
three connected words. His appearance and manner were very much 
as a man might be who was thoroughly intoxicated in his head, but not 
affected particularly in his legs. He was visited the day following by 



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THE CUNIQUE. 269 

two of his brothers, and yet has absolutely no remembrance of their 
visit, or how he came to be at the Pennoyer, except as he has been 
told. Four days after his arrival at Kenosha he began to realize his 
surroundings, was able to talk a little at times, and when again visited 
by a member of his family was very much pleased to see them, and 
still retains a memory of that visit. Eight days following his admis- 
sion to the sanitarium, he was able to talk clearly and understandingly 
of his past life and immediate surroundings. Within two weeks after 
coming under my care he, apparently, was about in his normal condi- 
tion. This apparent normal state continued until April 20th. The 
morning of the 20th he appeared as well as ever, dressed himself with 
as much care and taste as usual, went to breakfast and soon after went 
out for a walk, returning to his room about eleven o'clock. His nurse 
noticed a slight impediment in his speech, and within half an hour he 
was taken with a severe congestive seizure that lasted about five hours, 
and during this time he had eleven hard epileptiform convulsions. At 
present, April 22d, the patient is quiet, and his physical appearance is 
as good as ever. He can talk fairly well, and the power of observation 
is nearly normal. 

History. — To have a better understanding of this case, it will be nec- 
essary to have a fairly accurate history of Mr. A. Age 40 — married — 
two healthy children, and a manufacturer, in company with his 
brothers, — he is the technical man of the firm. The success of 
the company depended upon Mr. A's ability to accurately figure 
all contracts taken. He has always been a strong, hearty, robust man; 
has no history of ever having been seriously ill. From childhood up to 
the age of 16 he has a history of having had some type of fit; never was 
considered very serious by his family. At about the age of 19 or 20 he had 
a chancre. This never extended beyond the initial lesion, and was 
treated by his father's family physician, and the history of this syphil- 
itic infection came to me through the family doctor. He has always 
been a man who attended to business very closely, and was abundantly 
able, and willing, to carry an umlimited amount of business responsi- 
bility. 

Never from any point of view could he be considered a dissipated 
man. So far as the patient or any of his friends knew, he was as well 
as usual on the morning of November 16th, 1906, and apparently had 
a right to look forward to an active business career for many years. 

Symptom Complex. — To analyze the facts, and arrange them in form 
for diagnosis, we will first consider that we have an unblemished hered- 
ity. The fits that Mr. A. had as a boy are of very little account in my 
opinion. The syphilitic infection is the first serious symptom. 



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270 THE CLINIQUE. 

Where we can find a history of the syphilitic infection anywhere from 
eight to twenty years prior to a sudden and severe nervous breakdown, I 
feel that we are always justified in making a grave prognosis. From the 
age of twenty until forty we have an entire absence of anything that 
would have any bearing upon Mr. A's illness except this important 
feature. 

The rush, hustle, bustle and strenuous business life of the 20th cen- 
tury is fearful. I contend that the high pressure business methods of 
today are just as nerve racking, just as severe a form of dissipation as 
disreputable carousing. 

The syphilitic lesion that Mr. A. contracted at the age of twenty pre- 
pared a field for the illness to develop that came on at the age of forty, 
and this field was fertilized and cultivated by the intense energy that 
modern business methods demanded. 

Diagnosis. — When Mr. A. was taken from his office on November 
16th, 1906, to the near-by hospital in the city of Chicago, the attending 
physicians diagnosed his case as one of cerebral apoplexy. The same 
diagnosis was again made in the south as the same physician who attend- 
ed Mr. A. in Chicago happened to be near by, and looked after him there. 

When Mr. A. returned home and went to the first sanitarium, the 
physician in charge made a diagnosis of epilepsy. After he came under 
my care, a prominent physician and neurologist, of Chicago, was called 
in, and his professional diagnosis was neurasthenia. My diagnosis has 
been from the first, and is now, general paresis. 

Treatment. — Mr. A. has had a variety in the line of treatment. At 
one time he was taking over 300 grains of potassium iodide. He has 
been anointed with cerate of mercury. He has also been dosed with 
•chloral and bromide of potash. Since he has been under my care, his 
treatment has consisted of one remedy, and that was gelsemium tinct- 
ure, and careful, constant care by a competent trained nurse. 

Within one week from the time he began to take the remedy he 
changed from complete confusion, in which he was absolutely unable to 
realize where he was or recognize any one, to a clear mental condition. 

The treatment to follow will be a continuation of proper care and 
supervision, and gelsemium tincture so long as it seems to cover the 
case, and such other intercurrent remedies as conditions warrant. 

Of course, we are fighting an incurable disease. We may look for- 
ward to this man's living for from two to four years. 

My reason for bringing this case to your attention is that it is a fair 
sample of altogether too many that are developing day by day all over the 
country. The number of paretics are increasing too rapidly. 



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THE CLINIQUE. 271 

I want to conclude by attempting to leave this impression : We are 
living too fast a life — we are too strenuous; and second, our syphilitic 
patients are not sufficiently impressed by their physicians that they 
must remain under treatment from three to four years, instead of a few 
months, as so many of them do. 



DEVELOPMENT OF MAN AS AN ANIMAL. 



A BRIEF SUMMARY OF TALKS ON COMPARATIVE ANATOMY AT 
HAHNEMANN MEDICAL COLLEGE. 



MILTON H. BAKER, M. D., CHICAGO. 

To begin at the beginning, all matter is made up of substances which 
we have not as yet been able to separate into something more simple. 
These substances are called elements. All living tissue whether plant 
or animal is made up mostly of only four of these elements, C. H. O. 
N. , not alone of course but in the bulk. 

Matter used to be classed as mineral, vegetable and animal; mineral 
being said to grow, vegetable to grow and live, and animal to grow, 
live and move. We know now that some animals axe firmly fixed for 
at least part of their lives, some vegetables are lively movers for part of 
their life-time, and we are not at all sure that crystals are not alive. So 
that we find it to be practically impossible to draw absolute lines be- 
tween living and non-living, and between animal, vegetable and min- 
eral. 

Questions of physiology, life processes, require the study of the living 
cell processes. The size of the cell requires the use of the microscope 
and staining to see it, and staining kills the cell so we cannot watch the 
living cell processes yet to any extent. The best we can do is to accept 
the theory which seems best to explain the known facts, standing 
always ready to accept something else when it better explains the then 
known facts. From this standpoint, we will if you please accept the 
theory of evolution as being the best working hypothesis we have to 
account for the known facts as to animal forms, understanding that it 



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272 THE CLINIQUE. 

is not completely proven and ready to accept another theory tomorrow 
if it better explains the then known facts. 

Now all organisms whether plant or animal, are made up of single 
cells as a unit, as a brick wall is made up of bricks. You remember 
the definition of a cell: " A mass of protoplasm having sufficient in- 
dividuality to form a life history for itself." The cell theory of course 
is the foundation of all modern pathology and has made an immense 
difference in our understanding of all life forms. In dredging in the 
deep places of the ocean, three to four miles deep, they have found a 
sticky, gelatinous mass lying on the bottom of the ocean which men 
like Haeckel and Huxley think is alive. This mass is called protoplasm 
(first form). Now evolution suggests that this is the form in which 
life first appeared on the earth. Then, from this, separate cells were 
divided off and from these by development, differentiation, and combi- 
nation were developed all the forms of plants and animals which have 
ever appeared on the earth, up to the highest plant form like the daisy, 
and the highest animal form which we think is man. 

Right here let us say a word to some who at once resent the idea as 
the comic papers put it "that their grandmother was a monkey." 
Remember that no form living at present, such as gorilla, can possibly 
be the ancestral form from which Man was derived, since exhypothesi 
that ancestral form underwent modification and development and in so 
doing ceased to be. We have no justification for assuming that such 
low forms do more than present to us a collateral branch of the family, 
and that branch must in all probability, have experienced its own 
series of modifications. Again Maeterlinck says: " If we reject evolu- 
tion there is but the grand confession of scientific ignorance aware of 
its knowing nothing, and the hypothesis of the fixidity of the species 
and of Divine creation, which is less demonstrable than the other, and 
banishes forever the living elements of the problem, and explains 
nothing." 

Now let us draw a tree suggesting the plan of development of life 
from the beginning, remembering that such things must of course only 
be suggestive and are never to be considered as conclusive. Looking 
at our tree we find it to be rooted in this protoplasm at the bottom of 
the ocean. Now particles of this protoplasm become differentiated as 
separate cells. These are the first organisms, single celled organisms, car- 
rying on a complete life history. Since this beginning there have always 
been myriads of these forms. Yeast, moulds, green of Rochefort cheese, 
the bacteria we study in pathology — all these are examples. Watching 
an amoeba under the microscope, seeing it move about, wrap itself 



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THE CLINIQUE. 



2 73 



^nVhropotf ap e$ 



ttonWs 







*TOtopTkSTn— Bo^omo^ ocean. 



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274 THE CLINIQUE. 

about particles, absorb what it wants, unfold and move away, we notice 
that the whole cell does everything that is to be done, there is no dif- 
ferentiation of separate parts for separate functions, every part acts as 
sensory organs, as feet, as stomach. Later, after these single celled 
organisms were formed, we find two great groups formed, one taking 
on a cellulose covering which partly shuts it off from outside influences, 
developing chlorophyll and becoming plants. Another group not de- 
veloping^ membrane or chlorophyll and becoming animals. This is 
the great difference between plants and animals, plants by means of chlor- 
ophyll in the sunshine can use the inorganic elements in the air, earth, 
and water, to build structure, a progressive, constructive process, a 
synthesis, giving off oxygen, a deoxydization. Animals cannot do 
this; they must use organic structure as material, breaking it up, a de- 
structive, cleavage process, burning it up with oxygen, an oxydizing 
process. So far now we have single cells, plants and animals. Now 
we find that plants divide into two great groups — flowering and flower- 
less — flowering giving us exogens and endogens, and flowerless giving 
us ferns, mosses and fungi; fungi giving us all the bacteria. 

The lowest single celled animals we call protozoa, (first animals) such 
as amoeba, monera. Later single cells became associated together, first 
for some common purpose, although the separate cells can be separated 
and continue to live. Later two or more forming one complete insep- 
arable whole, thus forming the first, more than one celled, organisms. 
These we call metazoa, (after or between animal). This is the begin- 
ning of the greater part of animal life. Here the old classification was 
Molluscs, Articulates, Radiates and Vertebrates. For purposes of fol- 
lowing development we will say instead, Coelentura, Molluscs, Sea 
Squirts, Vertebrates, Annelida, Echinodermata and Sponges. Now 
notice how we have here a set of radiating developments, parallel de- 
velopments, experimental lines: 

Sponges. This group we are all familiar with. It gives us some 
very beautiful forms, and is one of the most studied groups at present, 
as in deep dredgings they are getting new and if possible still more 
beautiful forms. 

Coelentura. (Hollow bodied) such as coral. Both this group and 
sponges are a mass of separate cells living together for a common pur- 
pose, but not forming always a complete unit whole. Their purpose 
being perhaps to collect from the sea the silicon washed from the land 
and return it by building coral and other structures for use of land 
dwellers. Notice that these groups are communistic or socialistic. 
They perform the work they seem to have to do excellently, but seem 
to be very limited in their activity. 



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THE CLINIQUE. 275 

Molluscs. Oyster and clam. These deposit calcium in their shells; 
are a complete unit whole composed of many cells. Especially inter- 
esting to our school as we get our hepar sulphur and calcarea ost. from 
the shells. 

Echinodermata. (Spiny skin). Such as sea urchin and star fish. 
These deposit silica. 

Annelida. (Ring bodied). Body made up of ring segments. You 
remember the common angleworm is made up of a series of rings. So 
all the annelidae are made up of segments. This group soon divides 
into arthropods (joint foots) and vermes (worms); arthropods giving 
11s crustaceae (hard shell) as old ancient trilobite and crab, then the 
insects, (cut into). This is an immense group, some reaching a very 
high state of development, having at the top the bees and ants. Dar- 
win says that the brain of the ant is one of the most marvelous atoms 
of matter in the world, perhaps more so than the brain of man. Notice 
that these groups which have reached such a high state of development 
are also a communistic or socialistic group. The other primary branch 
of annelidae is vermes. This gives us all the worms. Here we find a 
fellow who seems to be a distinct connecting link between the vermes 
and vertebrates; he has a long acorn-shaped tongue protruding from a 
collar, so we call him balanoglossus (acorn tongue). He has structures 
closely approaching vertebrates but is a worm, so we put him as a con- 
necting link between the two groups. Notice that the annelidae in the 
insect has come to live out of the water and in the air and on the land. 

Now let us look at Sea Squirt, called so because he takes in water at 
an orifice and sends it out at a vent. He is also called Ascidian be- 
cause he looks like an old leather bottle (askidion). He is also called 
Tunicate (coated) because after a first part of life as a lively swimmer, 
he takes on a coat of cellulose, sinks to the bottom, becomes attached to 
a rock and lives like a plant. At first he was thought to be a plant, 
later his active life was discovered, so here is an example of degenera- 
tion, a retrogression. So we find in many places in evolution 
a retrogression as well as progress. This fellow became almost a 
vertebrate and then went backward. Right here let us look at Botifer. 
He is a puzzle, he seems near to vertebrate and yet is a worm. As yet 
^we are unable to classify him so we put him in a class by himself near 
vertebrates. 

Vertebrates. This is the class to which man belongs. Let us define 
it as, "An animal having a skeletal axis serving as a foundation for the 
skeleton, and in relation to this a dorsal nerve cord whose anterior end 
is expanded to forma brain." The lowest vertebrate is Amphioxus, 



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276 THE CLINIQUE. 

(double sharp) a headless double pointed worm about six inches long 
living in the sand. Then comes L,amphrey, an eel-like fellow. I^ater 
the Placoid fish, an ancient type to which our shark and ray are allied. 
Then the Ganoid fish of which our Sturgeon and Garpike are living 
fossils. These two forms in ancient times grew very large, as much as 
ten feet long, were covered with brilliantly colored shining enameled 
plates, had immense teeth and were veritable tigers of the sea. They 
had a skeleton made of cartilage. 

Then came the true bony fish Teleostei; these were the first true Ver- 
tebrates. The structural idea of a vertebrate is a spinal axis made up 
of a row of separate segments called vertebrae; this axis serving as a 
foundation for the skeleton as the keel serves as a foundation to a boat. 
Every bone in a vertebrate skeleton is developed from some part of a 
vertebra, meaning by this not man's " vertebra" but a theoretical, typi- 
cal, archetypal vertebra, which is considered as the original idea from 
which all vertebrae were developed. They have constructed a complete 
Archetypal Vertebrate skeleton for the study of the development of ver- 
tebrate forms. Fish is the first vertebrate, then comes Amphibia, Rep- 
tiles, Birds, and Mammals. 

Let us look at our ancient fish ancestor for a moment. Notice the 
backbone made up of separate vertebrae protecting the spinal cord in 
its arches, the cord expanding to form a brain, the backbone acting as 
a foundation for the skeleton, head joined to it, ribs joined to it, tail 
an extention of it. Notice that there are ribs the whole length of the 
body instead of just about the heart and lungs as in Man. As we go 
higher in forms toward man the number of ribs decreases until Man has 
only twelve. Notice the gills about the throat. 

Right here let us consider what is known as the " Biogenetic prin- 
ciple' ' that is that " the history of the race is repeated in the individual." 
This idea is very dominant in Kindergarten work. We find that the 
embryo of all vertebrates whether fish, dog, turtle, chick, monkey or 
man, passes through stages in the early part of its development that are 
just about the same, and the embryos are indistinguishable in these 
early stages. So the human embryo at first has a tail like a fish, begin- 
ning gill formations like a fish ; extremities begin as buds like a fish, 
heart like a fish. His great toe projects from the others and is short at 
first like a monkey's, he has a growth of hair all over but on the palms 
and soles, like a monkey, and this is shed before birth. All these things 
have nothing to do with the developed child and disappear before birth. 
They are only memories of the steps taken by the species in develop- 
ment. Prof. John Beard of Edinburg the Embryologist who is suggest- 



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THE CLINIQUE. 277 

ing a cause and a cure for cancer based on embryology says that the 
egg contains actual daughter cells of the original egg of the species, and 
so carries the memories of the accumulated experience of the race. 
This statement will look more reasonable when we remember that the 
egg of all vertebrates whether mouse, elephant or Man, is about the 
same size, 1-150 of an inch in diameter. Yet packed into this tiny 
mass are so many particles, that if one were Tost each second they 
would not be all gone for 5,600 years. So it can carry a large load of 
hereditary tendencies and memories. 

After fish come Dipnoi (double breathers). This is a mud fish liv- 
ing in India in shallow rivers and ponds, and when these dry up it bur- 
rows down in the mud and breathes by means of lungs, being provided 
with both gills and lungs. 

Then come Amphibia, able to live both on land and in the water. 
After them reptiles. One of these developed long finger- bones and a 
membrane between them making a wing, began to fly, Pterydactyl. 
Nature thought this was a good scheme and so developed Birds with 
feathers, the first one being the Archeopteryx. These were developed 
from Reptiles but distinctly are not reptiles. So our animals have come 
out of the water to the dry land and finally into the air. 

The last and highest group of Vertebrates is the Mammals. This 
means that these animals suckle their young. Up to this time an- 
imals have been egg-born (Oviparous). When the little chick or 
snake or turtle breaks the shell, it is ready to hustle for food and can 
practically use the food of the adult. It gains by heredity the knowl- 
edge necessary for life. During the short time until it is like the adult, 
it learns by example what the parent has learned of local conditions 
that will help it to live. With the Mammals we have a more and more 
complex life, and the young are unable to use the food of the adult so the 
mammary glands are provided to furnish food during infancy. During 
this infant stage, the young adds to the knowledge it received by hered- 
ity, the knowledge the parent has acquired of local conditions, and all 
the acts that will be helpful to it. 

As forms develop towards Man, life becomes more and more complex, 
and so the knowledge for the young to acquire increases, and corres- 
pondingly the time of infancy increases, until in Man the time has in- 
creased to fifteen years, and there is added the power of speech, so the 
accumulated intellectual activity of the race may be transmitted by pre- 
cept, in addition to the teaching by example and heredity. Animals are 
like a barrel-organ, can play one tune well, but their activities are lim- 
ited. Man is like a keyed instrument, can play anything, his activities 



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278 THE C UNIQUE. 

are unlimited. Before true mammals were developed there were many 
steps on the way. In oviparous animals the egg is developed in a sul- 
cus near the common genito-anal orifice. The egg is laid and hatched 
outside. There is a group in which the egg is hatched outside and the 
immature animal carried by the mother until mature. These having a 
common genito-anal orifice are called Monotremes. Here we have the 
Ornithorynchus Paradoxicus, (bird nosed paradox) a queer looking fel- 
low with a great ducks' bill, living in Australia where we have so many 
living fossils. He looks like an Otter with this ducks' bill attached. 
He is oviparous. A little further along we have Echidna. These are 
oviparous, but the immature young are carried in a pouch. Then come 
the true Marsupials. Young born immature and carried by the mother 
until mature, such as Kangaroo. Then come the Placentals, first the 
beginning placentals like Perameles. Later on the true human-like 
placental as Tarsier, a little monkey-like fellow, living a harmless, in- 
sectivorous life in the trees. 

This brings us to the true Mammals. Here we have many classifica- 
tions, the most accepted being based on the teeth. We will put down 
Ongulates, Rodents, Bats, Carnivorae and Primates. Man belongs to 
the Primates (first-class). 

Now let us look at position of the body. Fish live with the body in 
a horizontal plane, horizontal to a vertical line. Reptile and quadru- 
peds are the same, having their limbs always partly bent. Bird has 
his skeletal axis at an oblique line to a vertical and with bent legs. 
Monkey walks on the posterior pair of limbs supporting himself by the 
long anterior pair and with his skeletal axis oblique to a vertical, and 
legs bent. Man is the only animal standing erect on the earth with 
straight legs and skeletal axis parallel to the vertical, and with fore 
limbs free to use for head purposes. 

As the struggle for existence became more and more fierce on the 
surface of the earth, some animals were forced to take to the trees for 
safety, and developed special means of holding on to limbs. One group 
developed great long hooked claws and hung below the limbs like a 
bag. These rapidly degenerated and are now represented by the Sloth 
and Ant-eater, having very little intelligence. Another group devel- 
oped the grasping member, the hand. Shortening the claws to nails 
and placing the hallux opposable to the other digits produced the grasp- 
ing member. From this class comes Man, a Bimana (two handed) 
Homo Sapiens (Man the wise). 

So we find that we are descended from a group that failed in the 
struggle for place on the surface of the earth. An apparent failure, 



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THE CLINIQUE. 279 

but really they had something better than mere strength which led 
them to take to the trees. 

The first tree group is Prosimae ( before monkeys ) , Lemurs for instance. 
Then came true Quadrumana (four handed). Here our group Has left 
the surface and become arboreal ihstead of terrestrial. 

Down in Patagonia in the rocks of the early Tertiary period they 
found some years ago a skeleton of small size so much like a man that 
they called it the Little Man, Homunculus. We think that this is 
something like the form from which all the monkeys were derived. 

Monkeys we divide into Long tailed African, and two American 
groups, Capuchin and Marmoset. 

Now somewhere about this time was developed a form from which all 
the Anthropoid Apes were developed, and finally Man. This theoreti- 
cal form is called the Archetypal Man. 

In Java, in the rocks of the later Tertiary period they found a skele- 
ton about the size of a small man, looking so much like a monkey and 
So much like a man that they called it Pithecanthropos, (monkey man). 
This we imagine is something like the Archetypal Man, and from this 
were developed all the Anthropoid (man like) Apes, Chimpanzee, 
Orang, Gibbon, Gorrilla. 

These folks used their hands to throw stones and to hold boughs as 
clubs, and were immensely strong, like the Gorilla is now, so they be- 
gan to be able to hold their own again on the surface of the earth and 
became terrestrial instead of arboreal. 

From a form probably allied to the one from which Gibbon was de- 
veloped came the Neander Cave Man, and from him came Man, Homo 
Sapiens. 

So we finally have an animal intended to stand erect on the earth 
with a face turned from it, having two members free for head purposes, 
having speech, having greatly developed brain, and a long infancy to 
transmit to the young the accumulated intellectual activity of the race. 



Professor Rice offers the following as a dressing superior to carron 
oil in burns : 

R. White gelatine, oz. 7j£; Glycerine, oz. 1; Carbolic acid, dr. 1; 
Water, oz. 16. 

Soak the gelatine in the water until soft, then heat it on a water bath 
till melted. Add the glycerine and continue heating until a firm skin 
forms on the surface in intervals of stirring, then add the carbolic acid 
and mix all well together. Keep in well-stoppered glass containers. 
When wanted for use, it is heated on a water bath till melted, then ap- 
plied with a soft brush. It forms a strong but flexible skin. 



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280 THE CLINIQUE. 

SIGNIFICANCE OF ABDOMINAL PAIN. 

A. W. REDDISH, M. D., SIDNEY, OHIO. 

Twenty years ago most of the abdominal pains were unclassified gen- 
eral pains. Today, when we diagnose a case as gastralgia or enteralgia, 
our most obtuse patients will inquire for the cause of it, and yet our 
textbooks treat these conditions as' diseases. Every diagnosis of gas- 
tralgia must, in the end, be changed, when time has developed and 
classified the disease which stands in causative relation to it. 

The symptoms, which we usually recognize as belonging to gastral- 
gia or neuralgia of the stomach, are: Pain in the mid-epigastrium 
which radiates mostly to the left or to the back. The pains are severe 
and sudden in onset, lasting a few minutes or a few hours, with a face 
that shows pain in every line. Biliary, renal and pancreatic colic 
must be excluded as well as any spinal disease which might irritate the 
spinal nerves which supply this region. Every diagnosis of gastralgia 
should be tentative and entertained only long enough to enable the 
diagnostician to find the disease which stands in causative relation to 
it. In enteralgia or intestinal colic the pain is in the mid-abdomen and 
is relieved by pressure and by the passage of flatus. Jaundice is absent 
and no stones are found in the stools. Formerly most abdominal pains 
of a non-inflammatory nature were diagnosed enteralgia. Such diag- 
noses should today be made but seldom, for they do not satisfy our pa- 
tient and they should not satisfy the profession. We may have a neu- 
ralgia of a spinal nerve or a spasmodic contraction of the intestines 
giving rise to severe pain, but the suffering is only a symptom and the 
careful diagnostician should search for the cause. Tuffier says "by a 
minute and methodical analysis of symptoms and of causative data, 
combined with laboratory tests, you will, in the majority of instances, 
reach an exact diagnosis and thereby reach a rational treatment." 

We may have abdominal pains which are transferred to this region, 
but arising from diseases in the thorax. To this type of pain belongs 
the pains of the early stages of lobar pneumonia and pleurisy so often 
seen in children. Who among us has not been deceived as the child 
laid its tiny hand over the epigastrium, tense with muscular rigidity, 
and cried with pain. The fever, high pulse rate, rapid respiration, the 
absence of vesicular murmurs and the development of tubular respira- 
tions as the hepatization comes on will soon clear up the diagnosis- I 
have seen children, sick with empyema of the pleural cavity, com- 
plain of pain as low down as the umbilical region. 



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THE CLINIQUE. 281 

A great many of the secretory disturbances of the abdominal viscera 
are due to neuroses or functional derangements of the nervous system. 
Such troubles as brain fag, overwork, worry, disappointment, loss of 
sleep and spinal irritations stand in the relationship of cause to them 
by disturbing their nervous mechanism. Ofttimes enteralgia is due to 
over-distention, constipation and obstipation and to the pressure pro- 
duced thereby upon the sensory nerves. The pain is relieved by un- 
loading the colon. These fecal masses can be indented if deep pres- 
sure is exerted upon them and thus distinguished from other conditions. 
The anemic, neurotic, constipated woman with a pain in her side, is a 
familiar caller at every physician's office. Tabes dorsalis, in the early 
stage, causes lancinating pains in the abdomen and a cincture or'girdle 
sensation around the waist. Gastric crises also occur with sudden 
pains, vomiting lasting from several hours to several days and recur- 
ring at frequent intervals. 

Lead colic, accompanied by constipation, should not be overlooked 
among workers in paints. The blue line upon the gums will assist in 
the diagnosis. Gastro-intestinal adhesions will produce paroxysms of 
pain in the abdomen, recurring but not recovering until the cause is re- 
moved. This condition not only follows after surgical operations upon 
the abdominal organs, but it is quite frequently seen in irreducible 
hernias with adhesions. 

The intense pain in the spleen and liver during the chill or first 
stage of a malarial paroxysm, is familiar to all physicians who live and 
practice in the regions where the mosquito, anopheles, inoculates the 
people with malaria. Ulcer of the stomach causes intense pain after 
eating and sometimes pain is the only symptom complained of by the 
patient. It is usually confined to a small spot in the epigastrium, asso- 
ciated with frequent vomiting spells in which blood predominates and 
much free hydrochloric acid. The pain is increased by pressure and 
radiates to the back. 

In duodenal ulcer, vomiting is infrequent, and the blood, if present, 
is in the stools. The proximity of the ulcer to the intestinal end of the 
choledochus may induce jaundice. 

Acute indigestion is caused by overloading the stomach or to the in- 
gestion of under-ripe or irritating articles of food. The pains are cramp- 
like in the epigastric region, with bloating, fullness, heaviness, a load 
in the stomach and the formation of gas. An emetic or gastric stimu- 
lation quickly relieves the patient. 

Muco-membranous enteritis occurs in neurotic women and is looked 
upon as a neurosis. It may produce a contraction in the intestine, re- 



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282 THE CL1NIQUE. 

suiting in a tumor. The relationship of these tumors to the colon may 
be traced by palpation. With one hand in the iliad fossa and the 
other in the lumbar region, a hard cylinder, movable transversely but 
not vertically, may be made out. You may find one in the ascending 
colon, and another in the sigmoid. During periods of calm the colon 
is dilated and palpation will elicit splashing sounds, but then the pain- 
ful crises return again and with them the transversely moveable cylin- 
der in the line of the colon or sigmoid. These tumors are often asso- 
ciated with floating kidneys, because both conditions may be an ex- 
pression of ptosis and enteroptosis. 

Intestinal obstruction may be diagnosed by attacks of acute and 
sudden pain, no movements nor passage of flatus from the bowels y 
vomiting, first gastric then bilious, and then fecal, tympanitic disten- 
tion of the abdomen above the seat of obstruction, no fever, prostration, 
rapid pulse and collapse. Sometimes there is no pain accompanying 
obstruction. If the obstruction is caused by an enterolith, it has a 
hard feel to the palpating fingers and cannot be indented like a fecal 
mass. After the age of fifty the majority of obstructions are caused by 
malignancy. Strangulation is a common cause of obstruction and 
many preventable deaths are due to a failure to recognize them and 
advise early operation. A little knuckle of gut in the inguinal ring, 
thought to be a bubo, has filled many a grave. Umbilical hernias in 
women with a pendulous abdomen, are hard to operate, but are more 
dangerous to neglect. Strangulation may also be due to adhesions and 
to internal hernias caused by a loop of intestine slipping into natural 
slips, the foramen of Winslow, through the diaphragm or between an 
anteriorly fixed uterus and the abdominal wall. Pain and vomiting 
should cause careful inquiry to be made, followed by a most searching 
examination. 

Invagination or intussusception may be iliocecal, iliocolic, iliorectal 
or ileal. The onset in infants and in young adults is acute with tenes- 
mus and a discharge of mucus and blood coming from the gut immedi- 
ately below the invaginated portion. A sausage-shaped tumor may be 
felt occasionally, fever, rapid pulse, prostration and collapse closes the 
scene. Occasionally the invaginated portion sloughs off and a cure re- 
sults spontaneously. These cases require an early diagnosis to effect 
a cure. 

Volvulus, or twisting, is usually located in the large intestine, or 
sigmoid. The symptoms are those of invagination. 

In every case of abdominal pain, with vomiting and soreness, a most 
methodical analysis of associate signs and symptoms should be made. 



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THE C UNIQUE. 283 

Always search for the exact seat of pain, the maximum point of sensi- 
tiveness. While a pain may be transferred some distance from its ori- 
gin, an organ or hollow viscus that is sore to pressure is diseased. A 
tender appendix is a dangerous guest to entertain. A sore spot where 
the gall bladder projects itself against the abdominal wall is an ill omen 
of future trouble, and a spleen sensitive to pressure signifies that it is 
sore and enlarged. A positive diagnosis should be arrived at in every 
case, if possible, so as to differentiate the medical from the surgical 
cases. Our failures should be made the foundation of our future en- 
deavors. All signs and associate symptoms, clinical data and accumu- 
lated experiences should be utilized, for a correct diagnosis must pre- 
cede a rational treatment. 



ELECTRO-THERAPEUTICS IN PELVIC DISEASES OF WOMEN. 

MARGARET KOCH, M. D., ST. PAUL, MINN. 

There is no department of medicine wherein electro-therapy plays so 
important a part, or gives such brilliant and satisfactory results as in the 
treatment of pelvic diseases in women. It robs the surgeon of many 
a "pretty" case, and restores the mental and physical equilibrium of 
the patient in the shortest time, and in the easiest and pleasantest way, 
and in cases where operative procedures are absolutely indispensable, is 
a most valuable adjuvant. * 

The first and most important thing to learn in the use of electricity, 
is that it is a two-edged sword, and the power that is so potent for good 
when rightly used, may be a cruel destroyer when abused. It cannot 
be applied indiscriminately without disaster; while if intelligently ap- 
plied, there is no therapeutic agent more useful in office work. All 
forms of electricity are useful, each case must be carefully studied, and 
the current to be used selected with as much painstaking as would be 
necessary in selecting the similimum. 

A few general principles must be observed. By means of galvanism 
we can produce opposite effects, reducing congestion with the positive 
pole, and producing it with the negative, creating an acid medium with 
the positive pole, and an alkaline with the negative, producing seda- 
tion with the positive and irritation with the negative and so on. These 
varied effects, with the power to diffuse medicaments through the tissues 
makes galvanism perhaps the most important current in gynecological 
work. With faradism we get the tonic effect of massage and inhibition, 



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284 THE CLINIQUE. 

while the high frequency current might be called the pus destroyer, be- 
sides having other effects similar to the positive pole of the galvanic, 
without producing the irritation that is sometimes caused by that cur- 
rent. 

Regarding cataphoresis, there is probably no medicament more ac- 
tive than that formed by the action of the positive pole of the galvanic 
current upon the metal electrodes, and no metal which serves better for 
general use than copper, or copper amalgamated with mercury. This 
is the treatment par excellence for inflammatory conditions; endome- 
tritis, endocervicitis, salpingitis and ovaritis, using a uterine electrode 
for the two former, and the vaginal ball electrode for the two latter, it 
being my invariable rule never to give an intrauterine treatment if there 
is any congestion of tubes or ovaries. 

Where stimulation is required the negative pole of the galvanic cur- 
rent should be used, or faradism, or both. Take the cases of undevel- 
oped uteri, and many cases of dysmenorrhea and sterility are due to this 
cause; a mild negative galvanic current will bring more blood to the 
part and this combined with faradic massage, will soon develop a nor- 
mal uterus. A contracted internal os is best overcome by the use of 
negative galvanism, this treatment being much more satisfactory in the 
majority of cases than mechanical dilatation. 

In misplacements, a gentle faradic massage will do much to tone up 
and strengthen the ligaments after the congestion has been relieved by 
positive galvanism. 

In membraneous dysmenorrhea, that nightmare of both patient and 
physician, negative galvanism will do wonders, keeping the membrane 
in a soft or liquid condition. The treatment should be commenced 
immediately after the period, and given twice a week until the next 
period, using from twenty to forty milliamperes intrauterine with 
large indifferent pad on abdomen, usually two or three months will ef- 
fect a cure. 

For regulating the menstrual function, the galvanic current again 
comes in, using the positive pole to decrease, and the negative to increase 
the flow. Uterine fibroids also are satisfactorily treated with galvanism, 
using the positive current in vagina or uterus. A very successful 
method used by Dr. Neiswanger is as follows: a large hollow copper 
electrode containing small perforations, the outside covered with a layer 
of cotton while inside is placed a solution of adrenalin ; use a large in- 
different pad on the abdomen, and a current of from forty to seventy 
milliamperes can be used with little discomfort to the patient. This 
method cuts off the blood supply, reduces hemorrhage and cures 



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THE CUNIQUE. 285 

symptomatically, even in cases where the tumor does not entirely 
disappear. 

Ulcerations of the cervix and pus tubes I believe are best treated 
with the high frequency. The high frequency will also give good 
results in those cases where positive galvanism is indicated, but not 
well borne, as is the case with some highly nervous patients. 

The dosage varies with the patient, I believe the amount that can be 
taken without too great discomfort to the patient is best. 

Too strong currents, especially the galvanic, may cause uterine colic, 
and tend to frighten the patient. This however is not serious, as it 
can usually be relieved by rest, hot applications, and a few doses of 
cimicifuga. I consider rest after the treatment of very great import- 
ance, and usually insist upon it, saying " it is a part of the treatment." 



THE DIAGNOSIS OF TUBERCULOUS MENINGITIS. 

CHAS. V. MARTIN, M. D., CHICAGO, IIX. 

Of all serious cerebral diseases in children tubercular meningitis is 
the most common. Notwithstanding the fact that there is no symptom 
which may be considered as pathognomonic of tubercular meningitis 
the diagnosis of this disease in the majority of cases, exhibits few 
difficulties because of the course of the disease as well as the combina- 
tion of all symptoms. 

Tuberculous meningitis seldom begins suddenly amid complete 
health. For a week or two the patient is noticed to be unwell. The 
symptoms during this period vary a great deal but include restlessness, 
general malaise, mental apathy or irritability, and disturbed sleep, 
transient headache, coated tongue and impaired appetite, occasional 
vomiting is not uncommon, accompanied by a decidedly pale color of 
the skin, while this period may be absent it is present in the over- 
whelming majority of cases. These symptoms are produced by the 
development of tuberculosis in general in the system and it does not 
necessarily follow that it should be localized in the meninges; the 
lungs, peritoneum, etc., are equally prone to the infection. In cases 
where the pia mater is primarily involved these premonitory symptoms 
will be absent. Following closely in the wake of the period of pre- 
cursors it will be noticed that general malnutrition in the form of wast- 



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286 THE CLINIQUE. 

ing especially about the head and neck, extreme paleness of the skin 
with loss of appetite ; diarrhea, fever, and headache being absent. The 
parents have noticed that the child is languid, lazy, and irritable which 
cannot be attributed to any cause. Should this period be made mani- 
fest by a continued fever without local symptoms it may often be mis- 
taken for typhoid. As the disease progresses and the onset proper 
occurs with its ever present headache and vomiting, the latter being 
characterized by its peculiar expulsive character and by its being easily 
induced by changing the child's position from a horizontal to a vertical 
one. 

Vomiting rarely lasts more than four or five days and when it ceases 
for a period of twenty-four hours or more one may infer that it will not 
return. In doubtful cases in the commencement of the disease, the ab- 
sence of vomiting almost always excludes meningitis. 

In my observations the headache of tubercular meningitis has not 
been so severe as in the purulent or cerebro spinal type. 

The general appearance of the child would not lead you to believe 
that it was severely ill, there is slight apathy, keeps quiet in bed, does 
not complain or ask for anything, is only weak and unable to walk, 
which is attributed to dizziness principally. Apathy is slowly but most 
certainly followed by somnolency and this in course of time by com- 
plete coma. 

As the somnolency deepens the child awakes only upon painful irri- 
tation or perhaps responds only reflexly, and shortly before death the 
reflexes also disappear. 

The gastro-intestinal tract is a valuable aid to our diagnosis. We 
are quite likely to find a coated tongue associated with other diseases in 
which vomiting occurs, but in tubercular meningitis the tongue during 
the vomiting period usually remains quite clear. 

Constipation sets in from the very first which is especially interesting 
regarding the diagnosis. Despite the continued constipation there ex- 
ists the retracted abdomen which after a few days becomes boat shaped, 
41 due probably to the chemical changes in the intestines so that a small 
amount of gas is formed.' ' The abdominal symptoms should occur to 
one in the differentiation from typhoid or catarrh of stomach (in which 
there is an abundance of gas present) these diseases being most often 
confused with meningitis. " If in very young infants the constipation 
should be absent it could be explained perhaps by constipation being 
produced in meningitis by irritation of the splanchnic nerve and by the 
inhibitory nervous system in very young children being in poor 
activity." 



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THE CLINIQUE. 287 

When fever makes its appearance it rises progressively, with morn- 
ing remissions ranging from 99 to 101 y 2 F., very seldom higher than 
102 F., until the end of the disease, when it runs exceedingly high 
(105 to 107 F.). This usually occurs just previous to the fatal issue. 

The pulse as one of the characteristic signs is irregular and is in cor- 
respondence to the degree of fever present during the first week of the 
disease, but toward the end of the first week and sometimes even earlier 
it becomes slow and irregular. In children, 5 to 12 years of age, the 
pulse may fall as low as 50 or 60 per minute. Any slight diminution 
of pulse rate during fever should be carefully considered, for in children 
even comparatively slight (101.5) temperature is usually associated 
with a markedly accelerated pulse. After convulsions have appeared 
the pulse becomes accelerated more and more, reaching before death fre- 
quently 180-200 per minute, or so rapid and weak it cannot be counted. 

These irregularities are easily detected with the stethoscope even 
when they cannot be noticed with the finger counting the pulse. 

During the succeeding days when vomiting has ceased and pulse 
irregularity has become pronounced there is an irregularity of the respi- 
ratory movements of the diaphragm and the thorax. There is present 
a peculiar sighing respiration, as also the eye symptoms, dilation of one 
or both pupils, eyelids widely open, child rarely winks. If widely di- 
lated the pupils react slowly to light, strabismus and ptosis are fre- 
quently present. The ophthalmoscope may show the presence of tuber- 
cles on the choroid (not constant). During the last days of the disease 
the primarily pallid face is changed to one of bright redness due to vaso- 
motor disturbances. Contracture of the neck is also quite a constant 
late symptom as also facial paralysis, hemiplegia, opisthotonos and 
Cheyne Stokes respiration. As to the length of time the child will live 
we can usually say two to three weeks. One must be guided by the 
severity of the symptoms. As long as the pulse remains retarded we 
do not expect a very quick death, but as soon as the pulse becomes 
markedly accelerated then death is near and when it reaches 180-200 
we expect the end in from twenty-four to thirty-six hours. 

The inability to swallow sets in not earlier than 24 hours before 
death, but the rattling, gurgling respiration a few hours before. 



Woven catheters may be sterilized by boiling in saturated ammonium 
sulphate solution. Catheters and bougies may be kept aseptic if they 
are wrapped in gauze wet with the soap-spirits of the German pharma- 
copeia. — American Journal of Surgery. 



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288 THE CLINIQUE. 

BY WHAT MARKS SHALL WE KNOW THEM? 

A. E. SMITH, M. D., FREEPORT, ILL. 

Since the beginning, when God said, " Let there be light," and there 
was light, and His creating was finished with the creation of man, man 
has been constantly and continuously searching for more light, that he 
might understand how to accomplish his mission in life; securing the 
greatest results from the smallest amount of expended energy. How well 
he has succeeded let each man determine for himself, for man rarely stands 
in a more favorable light than when he is the judge of his own accomp- 
lishments. Seldom do we find a man as eager for more light as was 
the illustrious founder of the school under whose banner we sail our 
craft. Seldom do we find the hope for success shrouded in deeper 
gloom, or advancement beset with more numerous or greater obstacles 
than was this young aspirant's pathway. 

There seems to be an indescribable something in the nature and 
make-up of every boy sometime, between the years of childhood and 
adult life or the period of adolescence, that yearns for something not 
always within the ability of loving parents to give or administer unto in 
an entirely satisfactory manner; and so we find it was with Samuel 
Hahnemann, notwithstanding the father saw and administered unto ac- 
cording to his best knowledge and belief; Samuel in his eager ambition 
and thirst for more light and knowledge among matters medical, wor- 
ried and fretted under this tutelage until his indomitable determination 
to succeed in acquiring a knowledge of medicine, eventually, overpow- 
ered the parental persuasions, brought him in contact with the then 
celebrated Vienna physician, Von Quarin, who discerning the ambition 
of this young pupil was animated with a desire to assist him and through 
this kindly assistance, Hahnemann was enabled to still further pursue 
his studies along medical lines; although poverty daily looked in at his 
door, until 1779 when his efforts were crowned by his receiving the de- 
gree of Doctor of Medicine and he went forth to practice his chosen pro- 
fession. This he followed in accordance with the instructions that he 
had received along the line, until he was thoroughly convinced that the 
ship in which he had embarked had no helm, and it was then that he 
set himself to work to find one that all future students and practicians 
of the science and art of medicine might have a uniform guide to direct 
them in the use of internal remedies when administered for their thera- 
peutic action; not that he was ambitious to overthrow or criticise any 
established usages that had demonstrated their efficiency, but on ac- 



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THE CLINIQUE. 289 

count of the early lessons in thinking that he had been taught, he 
thought for himself and for himself decided that there must be some law 
whereby man might be guided in administering internal remedies for 
their therapeutic action to the sick and afflicted. His studious investi- 
gations put him far in advance of the times in which he lived. We 
find today in all branches of business, particularly in the science and 
art of medicine and surgery great advances being made because those 
interested therein are looking for more light, thinking for themselves 
and for themselves deciding on what they can, in accordance with the law 
or in a wise and conscientious manner, therapeutically apply for the re- 
lief of those to whom they administer. 

No wonder that some stumble and fall while groping in the Egyptian 
darkness of their despair to secure a therapeutic agent according to the 
law in the shape of an internal remedy when the case is one that de- 
mands mechanical support and assistance. 

I have a case of severe post-partum hemorrhage; my case has been 
looked after from the surgical standpoint but naturally there is great 
exhaustion of vital forces, an ashen deathly pallor, nausea, cold clammy 
perspiration, weak trembling voice, a scarcely palpable pulse, great 
restlessness, anxiety and moaning, sudden sinking of strength and great 
thirst. Would my prescription of arsenicum alb. differ widely from yours, 
with such a train of symptoms as I have related ? Certainly not if Dr. 
Cowperthwaites' text book of Materia Medica has been your rule and 
guide in selecting the indicated remedy, and yet, who could conscien- 
tiously, in this enlightened day and age, prescribe arsenicum alb. in such 
a case and feel assured that all was being done that human minds could 
direct to support this life ? How many are there in this company as- 
sembled that would not think of the necessary mechanical brace in this 
case; with a heart that was thirsting for more blood to stimulate its 
contractions that it might continue to act in its double rhythmical 
motion so absolutely necessary to the maintaining of the normal rela- 
tion between body and soul? What a well adjusted splint and band- 
age is to a fractured bone so is a hypodermic injection of 1-60 to 1-40 
of a grain of strychnine to that heart whose walls are losing their power 
of contraction for want of work to be done and absolutely need the goad 
to urge them on to perform their function. 

How many of us have seen one or more patients in a similar condi- 
tion pass into the world beyond because the alimentary functions were 
impaired by the lowered vitality of the individual, due to loss of blood, 
or perchance the metabolic powers were too benumbed to properly ap- 
propriate remedial agents coming by the way of alimentation. Is not 



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290 THE CLINIQUE. 

the mission of homeopathic physicians and surgeons to bind up broken 
bones, to relieve suffering and distressed humanity and to maintain 
lives as long as possible? Must we too maintain our standing as such, 
sit by and administer the attenuated indicated remedy and watch me- 
chanical forces crush the very life out of our patients ? Shall we refuse 
to use mechanical means that are so urgently demanded, because some 
members of the profession choose to advocate materia medica as the 
only therapeutical agent from a fanatical standpoint ? 

My good friend Prof. N., a teacher in a well regulated homeopathic 
institution, teaches at all times the use of highly attenuated remedies to 
his students, but when called in consultation, by one who had listened 
to his lectures for many an hour, looked over the case in question care- 
fully, formed his diagnosis and then said, " What is your treatment? " 
The young doctor, true to the education that he had received from his 
Hnstructor replied, giving the name of the remedy, its potency and the 
frequency of dose administration; he was however rebuked by his idol- 
ized professor with the statement, " but this is a desperate case and we 
cannot rely on anything higher than the mother tincture and that in 
oft repeated doses." Which situation are we to accept as bearing the 
ear marks of a true homeopathic physician ? 

My good friend Dr. W. says "you cannot learn homeopathic medi- 
cine unless you learn it in a homeopathic college; " this may be true in 
a way, but one of the best posted and most enthusiastic materia medica 
men I ever met in the homeopathic profession is my good friend Dr. 
G., a graduate of a regular institution who, like Hahnemann, became 
disappointed in his practice because he thought for himself, was deter- 
mined to understand and have a reason why, so he began to investigate 
and was not long in determining that the law of similars was as much 
for him as any other man if he would only study and learn how, when 
and where to apply it. Many a graduate of homeopathic institutions 
would be glad to be able to make as satisfactory a selection of the in- 
dicated remedy as this good student and doctor, and yet he never saw 
the inside of a college where the law of similars was taught. Shall we 
say that he has the necessary marks and should be listed as a homeo- 
pathic physician? 

My good friend Dr. M. a graduate of both a homeopathic and regular 
college is listed in Polk's register as a homeopathic physician, yet he 
purchases his stock of medicines from Morrisson Plummer and Co., P. 
D. and Co., Wm. S. M. Chemical Co. and like institutions. His pre- 
scriptions are compounded from fluid extracts, salts, elixirs and all 
manner of drugs and in all manner of combinations. Could we accept 



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THE CLINIQUE. 291 

these as ear marks of H. P.? Are my good friends Drs. Me., Ad., and 
others, graduates of allopathic colleges, who, twenty years ago could 
see no virtue whatever in homeopathy and had no use for one of that 
school but who today are studying homeopathy materia medicas, pur- 
chasing their drugs from homeopathic pharmacies (perhaps with no com- 
pliment to the pharmacy) preparing some of their remedies according to 
the recognized form of our school, any the less allopathic? If yes, then 
is there not a trend of the regulars toward homeopathy? And what 
more could we expect in a few short years? And if no! then we as 
graduates of the homeopathic institutions cannot be considered the less 
homeopathic, even if we should, at times, prescribe compounds and 
administer remedies from an empirical standpoint. 

From the present situation of affairs there can be no question as to 
the foresight of Huflander, in his predictions nearly one hundred years 
ago, when he said " there will be a gradual amalgamation of the more 
liberal members of the two. schools. " And if the philosophical reason- 
ing, not by extremes but by golden means, is true, and via this route 
•we attain the highest state of perfection, is it not a mark in favor of 
homeopathy to have a graduate from the dominant school use even one 
remedy and use it homeopathically ? Should we have in our tnakeup 
an ambition to show what we can do with homeopathic remedies pre- 
scribed in accordance with the law or is it better for the cause to clothe 
ourselves with an impenetrable garb and learn to neither give nor take ? 

Figuratively speaking we can divide a certain percent of the gradu- 
ates from homebpathic institutions into Jews and Greeks for as Christ 
crucified was unto the Jews a stumbling block and unto the Greeks 
foolishness so the law of similars seems to be with this certain percent 
of our numbers ; and while none are perfect, no not one, yet men gener- 
ally know to which political party they belong and while they may now 
and then scratch the ticket, caring not who knows it,' they are never 
ousted from the primaries but always considered party members ; and 
I for one fail tp see wherein there is virtue for the cause by deposing 
•the average doctor that is struggling with homeopathic materia medica, 
symptomatology and public opinion for a livelihood. 

The laws of Galva and Volta stand as true and unshaken today as 
when they were given us by these great scientists, nothing is taken 
from or added to them as laws in electricity; yet we would be consid- 
ered stupid indeed if we could not see the advancement in the latter 
■day reasonings of Maxwell Hertz, Marconi and others whose demonstra- 
tions sprung originally from the law of Volta, Ampere and Ohm. The 
laws of nature do not permit the arts and sciences to remain stationary, 



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292 THE CLINIQUE. 

we must either advance or retrograde. As a school in which class have 
our opponents placed us? In which class do we consider ourselves in- 
dividually? 

The old saying that " you can lead a horse to water, but can't make 
him drink," is a homely one, but certainly there is great virtue in the 
sentiment expressed. I believe that if we will perfect our materia 
medica, systematize our symptomatology, encourage consideration of our 
school by being proficient in its law and at the same time demonstrate 
that empirical prescribing is not our practice, that we will be doing 
much to retain those in our midst that have endeavored to learn, under- 
stand and practice in accordance with the law. And if we favorably 
attract the attention of those that are not familiar with our methods of 
prescribing, it will redound to the honor and glory of the cause that we 
represent. Being wfcll informed are we likely to obtain ill results, 
when with unselfish motives we work with zeal and earnestness for a 
good cause? 



CANCER OF THE ALIMENTARY CANAL— TWO CLINICAL 

CASES. 

.*> E. E. VAUGHAN, M. D., CHICAGO, ILL. 

Careful study has established the fact that in over half the cases in 
which death is attributed to cancer ; primary lesion was in the digestive 
tract. While cancer of the lips is very common without any assign- 
able cause, it is rarely found as a primary invasion at the anus, while 
cancer of the rectum is common. 

The stomach is most frequently attacked of the alimentary canal, and in 
fact stands third according to some of our best authors in order of fre- 
quency; the breast being the first, and the uterus the second in order. 
The small intestines are rarely attacked, but the colon and rectum fre- 
quently, the sigmoid flexure and the rectum most commonly, but very 
rarely found to exist in the appendix, cecum or cecal-valve. It is dif- 
ficult to explain the frequency of its presence at the iliac-cecal valve, 
and the great frequency of its occurrence at the pylorus. 

In the esophagus we find two varieties of cancer, the squamous celled 
and the glandular type, the former usually found in the upper portion, 
the latter in the lower. This disease exhibits a strong preference for 
the male sex, being found three or four times oftener in men, and like 
cancer in other localities, most frequently between the ages of forty and 



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THE CLINIQUE. 293 

sixty years, but has been observed as early as thirty and as late as 
eighty. 

The premonitory symptoms are few until surrounding structures be- 
come involved; its course is rapid, often terminating fatally within less 
than a year, producing death in different ways, such as obstruction, ex- 
haustion, pleurisy, septic pneumonia due to perforations of the pleura 
and trachea. Pneumothorax is rarely caused by perforations into the 
pleura; perforations into the trachea are common. Abscesses frequently 
form in the mediastinal space which have occasionally caused ulcera- 
tion, burrowing its way to the aorta. The recurrent laryngeal nerves 
may become involved, causing paralysis of the laryngeal muscles 
when occupying the upper part of the esophagus. 

Secondary lymphatic involvement in the cervical region sometimes 
occurs. Dissemination is, however, rare. Surgical treatment has been 
attempted in the upper part of the esophagus; the results, however, 
have not been good and gastrostomy is most useful in these cases serv- 
ing only of course to delay the disease. 

In the stomach the disease originates in the glands which we find so 
abundantly distributed in its mucous membrane. The epithelium is of 
the columnar variety and the cells undergo a colloid change quite rap- 
idly. We cannot tell exactly how the cancer begins; it is most com- 
monly situated, however, at or near the pylorus, rarely occurring at the 
cardiac orifice; sometimes it seems to attack the edges of chronic ulcers 
or their cicatrix. The mucous coat is first invaded, then the muscular 
and later the serous, and in the neighborhood of the pylorus the infiltra- 
tion gradually closes the opening. Ulceration, sloughing and bleeding 
take place in the order named; the bleeding sometimes becomes so pro- 
fuse that life is ended thereby and again frequently hemorrhage will 
occur without seriously weakening the patient. While these processes 
go on upon the surface, the tissues (muscular and peritoneal) become 
infiltrated, forming adhesions to all contiguous structures, often extend- 
ing to the liver, transverse colon, pancreas, gall bladder, and in some 
cases even the spleen and diaphragm, extending along the lesser curva- 
ture of the stomach. The surrounding lymph glands are usually af- 
fected. 

In cancer of the stomach, the rule of dissemination is the opposite to 
that existing when the esophagus is attacked being most common, no 
organ scarcely being exempt. The condition of the omentum usually 
associated with cancer of the stomach is not well understood, but is re- 
ferred to as colloid or hydatid tumor, myxo-sarcoma of the omentum, 
etc. The omentum is greatly thickened, having weighed as high as 



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294 THE CLINIQUE. 

eight or ten pounds. It also runs a very rapid course, life being seldom 
prolonged, after recognizing the disease, beyond one year. 

There are many forms of treatment advised and many cures claimed r 
but we have no authority for giving these statements much credence. 
In the early stages, wide excision is the treatment advocated and to 
date most successful, but rather discouraging at best, recurrence being* 
the rule or at some other part. When cancer attacks the rectum, it 
can be recognized by a hard nodular mass, slowly spreading around. the 
bowel, forming a contraction with perforation somewhat centrally 
located often no larger than a small lead pencil and finally completely 
obstructs the bowel. In other cases it extends from its primary lesion 
both up and down as well as in the surrounding tissues involving the 
prostate gland, bladder and connective tissues to the pelvis. Most 
patients so affected succumb from the effects of the obstruction, gan- 
grene is occasionally the cause of death, caused by intestinal distention 
above the location of the growth, resulting in ulceration and perfora- 
tion. 

Treatment: In some instances proctotomy may be performed with 
good results. If the index finger can reach beyond the growth and if 
the same is movable it is considered an operable case. When excision 
is out of the question, colotomy may bring limited comfort to the pa- 
tient. This operation, however, is performed far too frequently and 
should, in my opinion, only be employed when obstructions exist so 
completely as to prevent the fecal matter from passing. 

I now have occasion to report two cases — one cancer occurred in the 
so-called rare district. Man aged 55 years with a history of repeated 
attacks of diarrhea associated with severe pain, covering a period of ten 
years. Finally these attacks became associated with extreme and ex- 
cruciating pain. Repeated physical examination revealed little or 
nothing. Following about one year of this extreme suffering an opera- 
tion was decided upon and the writer was called to Columbus, Ohio, to 
participate in the work. There was no visible tumor except during- 
these attacks of pain -disappearing with a gurgling sound after hours 
of suffering. The incision was made at McBurney's point and the mass 
discovered involved the lower part of the ascending colon, upper part 
of the cecum, ilio-cecal valve and about one inch of the ileum. The 
entire mass was removed including the cecum and appendix, uniting 
the ileum to the ascending colon. Specimens were examined by two 
prominent laboratories, one pronouncing the growth malignant, the 
other benign. The patient made a good recovery, being able to visit 
Chicago, and, being a preacher, took a pulpit in an eastern state where 



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THE CLINIQUB. 295 

he labored for about six months without interference. A similar condi- 
tion, however, returned, made rapid progress and in about nine months 
caused the death of the patient. 

Case No. 2. Woman, suffering from what seemed to be a simple 
obstruction, which was finally diagnosed as a floating kidney combined 
with intestinal obstruction, suffering little pain except when fecal mat- 
ter obstructed the passage. She was sent to the hospital, and after ten 
days the obstruction entirely disappeared and a movable tumor re- 
sembling the shape and size of a kidney appeared and occupied the 
proper location of the kidney. 

After consultation the writer decided to operate and made an explora- 
tory incision at a point just anterior to the quadratus lumborum muscle. 
The opening revealed a growth incased within the ascending colon 
which was invaginated and hardened for about four inches with a round 
cauliflower like growth within the lumen of the bowel. The entire 
mass was widely excised and an end to end anastomosis was made. 
The wound closed with drainage. The patient made an uninterrupted 
recovery and the microscope gave the evidence of sarcoma. Two and 
one half years have now elapsed and the health of the patient remains 
good. 

THE WISCONSIN STATE SOCIETY. 

The Homeopathic Medical Society of the State of Wisconsin will 
hold its annual meeting in Madison, Wisconsin, May 22d and 23rd, 
1907. Headquarters will be established at the Park hotel and the 
meetings will be held in the supervisors' room of the Dane County 
court house. Ample accommodations are provided for all who will 
come. 

An interesting program has been arranged which will be presented 
under nine different bureaus. — The evening session will be devoted to a 
social entertainment in the parlors of the Park hotel. A special invita- 
tion is extended to the wives of all our doctors to be present and enjoy 
a two days' outing at our State Capitol. It is especially desired that a 
large representation of homeopathic doctors be present at the meeting 
and participate in the discussions. 

Representatives of the American Medical Association are making the 
claims that homeopathy is dead in Wisconsin. Let us turn ont in full 
numbers to this meeting and demostrate to them that they are mistaken 
in their diagnosis. Visiting members from other states are always 
welcome. " Come over and help us. n Remember the place and the 
date. [This notice was received too late for classification in Society 
department. ] 



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THE CLINIQUE. 

$2.00 A YEAR, IN ADVANCE. SINGLE COPIE8 20 CENTS. $2 50 A YEAR POSTAL UNION. 

OFFICES OF PUBLICATION - \ CHICAGO*. Ill"" 

ENTERED AT THE PO0TOFFICE AT LANtING, MICHIGAN AS «ECOND-CLA«8 MATTER. 

MAY, 1907. 

The editor of The Clinique is not responsible for any opinion expressed by a con- 
tributor. Contributions are respectfully solicited, and will be published whenever 
available, providing they are free from personalities, and are not otherwise objection- 
able. Articles for publication, books for review, exchanges, etc., should be sent to the 
editor, 70 State St., Chicago. All business communications should be directed to the 
business manager, Wm. Byford Taylor, 141 Kinzie St., Chicago. 



%&xtavinl. 



The Standing of Hahnemann College. — The third annual confer- 
ence of the council on Medical Education of the American Medical 
Association met in Chicago, Monday, April 29th. The work reported 
upon as having been completed during the year that had passed was of 
the most interesting character. Whatever one may think of the results 
attained the attempt of the committee upon Medical Education to in- 
spect every medical college in the United States, to mark each one on 
the standing of its graduates before the state boards, its dispensaries, 
its laboratories, its libraries, its hospital accommodations, its course of 
study, the duration of its term, the character of its faculty, exactly as 
one would a medical student upon examination, and then to classify the 
colleges according to this marking is something unique. 

Never before, we believe have the colleges been subjected to such close 
scrutiny, and never before, as we believe, has there been an attempt to 
systematically classify colleges on the basis of certain definite require- 
ments. We are not in a position, of course, to verify the report of the 
committee. We are not in a position to state whether in every instance 
the colleges examined have been justly dealt with. We believe from 
the report made that the intention was to deal justly with each college, 
but it is quite possible that in some instances the examination was made 
under unfavorable circumstances, at least, we cannot account for 
the position accorded certain colleges which we have always believed to 
possess first-class advantages. According to this report all the colleges 



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THE CLINIQUE. 297 

in the United States were classified into three divisions accordingly as 
they were marked above seventy, between fifty and seventy and below 
fifty. 

Into the first division was placed what is known as first-class colleges. 
In the second division was second-class, or colleges which might under 
certain circumstances be made first-class, and into the third division 
those that were recommended to the state board as not meeting the re- 
quirements for good medical education. In the city of Chicago four 
colleges were placed in the first-class — Hahnemann Medical College, 
Rush Medical College, Northwestern Medical College, and the P. & S. 
College. With one exception, we believe, the Bennett which was 
placed in the second-class, the remainder were placed in the third-class. 
The homeopathic colleges throughout the country placed in the first- 
class were the Hahnemann of California, the homeopathic department 
of the Iowa University, The Hahnemann of Chicago, the homeopathic 
departments of Michigan and Minnesota, Philadelphia, New York, and 
the Boston University. G. F. s. 



What's the Matter With Illinois Homeopaths? — The Cunique is 
the official organ of the homeopathic physicians of this state, and yet 
the months that have passed since the present editorial staff has been 
in charge of the journal have convinced the editors that the home- 
opathic physicians are not very much interested in practical homeop- 
athy. 

We have asked repeatedly for reports of clinical cases which empha- 
size the application and truth of the law which we claim to believe in. 
Yet we have scarcely averaged one article of this kind per month. 

Does this mean that the five hundred homeopathic physicians in this 
state who receive the Cunique are not vitally interested in demonstrat- 
ing and placing on record proof that the law of similars does apply? 
Or does it mean that they are too lazy to spend a little effort toward the 
promulgating of this therapeutic truth? The Clinique of some 
years ago was a constant militant advocate of this law, and a source of 
help to its readers because it did contain regularly each month a num- 
ber of clinical cases reported by men who were earnest followers of this 
therapeutic faith. 

We have no difficulty in getting articles about operations, and path- 
ology and diagnosis, and the latest electric and mechanical apparatus, 
but articles showing practically that we do get results*from application 



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298 THE CLINIQUE. 

of the law which makes us a distinct school and alone justifies our be- 
ing such are almost impossible of attainment. 

Each reader of this editorial outburst will please take it to himself 
and earnestly co-operate this year in making this journal what it should 
be — an exponent of the homeopathic law of therapeutics. If each 
reader would send only one case per annum we would have such a 
wealth of evidence that the most skeptical could not fail to understand 
the " reason for the faith that is within us." v. R. 



Conflicting Meetings. — It is apparent that each state homeopathic 
society is proceeding on the theory that independence is a source of sat- 
isfaction, for a majority of them occur on the same dates. Illinois, 
Ohio, Wisconsin, and Minnesota, great and adjoining states, have their 
meetings so near the same date that the attendance must be confined to 
their own practicians. This is indeed unfortunate, for it is very desir- 
able that there should be something of an inter-state attendance at each 
meeting. There are many physicians who would like to go to several 
of these meetings, but cannot unless they leave their own. Thus the 
general interest in medical societies is lagging and we are obliged to 
thank our carelessness for this. It only requires a little thought on the 
part of our managers to correct this error, and we hope this matter will 
be given consideration at the coming meetings. An interchange of 
attendance is what we need for instruction and for the right kind of 
enthusiasm. h. v. h. 



Indiana's Advocacy of Sexual Mutilation. — Under this head Dr. 
Frank Kraft in the American Physician for April indulges in a half- 
humorous but wholly flippant discussion of a subject which merits more 
serious consideration. The writer feels certain that Dr. Kraft must 
have been in urgent need of an editorial filler, and wrote without giving^ 
due thought to the real principle involved. We hope that some day he 
will give us a serious discussion of this subject. 

The Bill is as follows: 

" A bill for an Act entitled an act to prevent procreation of confirmed 
criminals, idiots, imbeciles, and rapists; providing that superintendents 
and boards of managers of institutions where such persons are confined 
shall have the authority and are empowered to appoint a committee 
of experts, consisting of two (2) physicians, to examine into the 
mental condition of such inmates. 



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THE CLINIQUE. 299 

" Whereas, Heredity plays a most important part in the transmission 
of crime, idiocy, and imbecility; 

" Therefore, Be it enacted by the General Assembly of the State of 
Indiana, That on and after the passage of this act it shall be compul- 
sory for each and every institution in the state, entrusted with the care 
of confirmed criminals, idiots, rapists, and imbeciles, to appoint upon 
its staff, in addition to the regular institutional physician, two (2) 
skilled surgeons of recognized ability, whose duty it shall be, in con- 
junction with the chief physician of the institution, to examine the 
mental and physical condition of such inmates as are recommended by 
the institutional physician and board of managers. If, in the judg- 
ment of this committee of experts and the board of managers, pro- 
creation is inadvisable and there is no probability of improvement of 
the mental condition of the inmate, it shall be lawful for the surgeons 
to perform such operation for the prevention of procreation as shall be 
decided safest and most effective. But this operation shall not be per- 
formed except in cases that have been pronounced unimprovable: Pro- 
vided, That in no case shall the consultation fee be more than three 
($3.00) dollars to each expert, to be paid out of the funds appropriated 
for the maintenance of such institution." 

Dr. Kraft says: "If a committee of experts * * * ma y deter- 
mine upon unsexing a man * * * because of mental or moral ob- 
liquity, why may they not also have the power to mutilate other parts 
of the body presumed to be the prime instigator of mental disease ? If 
mental disease, on the other hand, is the source of wrong doing, is cast- 
ration the proper correction therefor ? n Certainly the writer of the 
above quotation has entirely missed the real principle involved in 
the subject under discussion. No advocate of the prevention of pro- 
creation of defectives has to the writer's knowledge ever claimed that 
such a procedure would make anew the defective, or correct mental 
disease if present. The great vital fact in the matter is the increasing 
number of defectives, mental and moral, because defectives are allowed 
to propagate their kind. A superficial study of the Jukes family which 
descended from two criminals and numbered some 700 individuals, of 
whom over two-thirds were criminals, prosecution of whom cost the 
state of New York over one million dollars, will convince one that too 
little effort has been made along the lines of the bill under discussion. 
It is strange that while we carefully regulate the procreation of domestic 
animals, society has done little to prevent defectives from multiplying. 
As a result, our institutions are full, and a host who need institutional 
care are at large. 



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300 THE CLIN I QUE. 

As to the criminal, — the habitual criminal and rapist, — the former in 
time is discovered to be such by returning again and again to the pris- 
ons. The latter deserves little charity. 

Is it not true that such individuals are exceedingly jealous of their 
sexual functions; that craving new sensations and especially physical 
ones more than the well-balanced, they contemplate with great horror 
the loss of those functions ? Is it not reasonable that the knowledge of 
such treatment as this bill provides for, will act as a greater deterrent 
of crime than the fear of imprisonment or even the death sentence ? 

Dr. Kraft also says: u An unmanned man, deprived of that which 
made him a (physical) man, turned loose upon society once more might 
almost be justified in living thenceforth the life of a ferocious brute, 
such an one he has been turned into, wreaking upon that society other 
and more murderous possibilities than the former ones of procreating 
undesirable or even criminal progeny." This thought loses its force 
when one considers the results of castration, and by that is here meant 
any procedure which makes procreation impossible. In the animal 
world it is well known that this results in a marked change of disposi- 
tion; unruly and ferocious brutes become docile and easily managed. 
The entire disposition becomes changed and decidedly for the better. 
The writer has learned that in a certain penal institution vasectomy 
(resection of the vas deferens) has for some time been performed on in- 
tractable and habitual criminals with the happiest results. They have 
become quiet and orderly and in fact exemplary prisoners. If, as 
seems to be the case, such procedures will convert a lawless individual 
into a law-abiding citizen, if it will change him (or her) from a menace 
to society to a server of the same, and finally, if it will prevent the mul- 
tiplication of defectives as it must do, every physician should put forth 
efforts towards the enactment of such a bill as this in every state. 

v. R. 



Conspicuous Vulgarity. — A remarkably suggestive cartoon appeared 
in one of our daily papers a few weeks ago, which ought to be given 
wide observation; it had reference to a murder trial of recent date, 
which has been given altogether too much publicity and comment; it 
was published when the jury in this case were wavering on the verdict; 
" waiting for the verdict n was the headline; the picture beneath had 
in the foreground a well dressed scion of a wealthy family, who was 
labelled as the "next degenerate killer;" in one hand he grasped a 
partially concealed revolver, while in the other he was holding a mod- 



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THE CL1NIQUE. 301 

era yellow journal, and was eagerly reading the large headlines which 
announced that the " jury was still out;" in his mouth was the conven- 
tional cigarette, and underneath all of this was the significant object les- 
son of the cartoon: " Is it going to be safe to shoot ? " 

If a more marked illustration of modern journalistic error can be pre- 
sented, we should like to see it. And if anything is more typical of the 
tendencies which are liable to prevail among the youths of wealthy 
families, where money that has not been earned has bred a tolerance 
which in many instances has led to degeneracy, we have failed to see it. 
We cannot have too many of these illustrations to bring home to its the 
danger which is lurking in the midst of our social relations, and which 
sooner or later will increase our moral depravity to the extent that we 
shall leave the coming generation a problem which sometime will be 
extremely difficult to solve. But more than all is our tolerance of a 
depraved journalism. The freedom of the press has grown to be a 
contemptible license ; like the saloon and cheap concert hall it flaunts 
the details of vice in the face of the public ; it is permitted to enter the 
sanctity of the home on mere suspicion and portrays, in large and 
attractive type, the most minute differencies in family life ; it is allowed 
to publish the most disgusting facts of degenerate carousals as an illus- 
tration of the privilege which a young man with money may enjoy ; it 
tempts the young to ape these examples of high life which none but a 
real degenerate can enjoy ; it sympathizes with the unfortunate fool 
who commits crime under intoxication on the ground that he has re- 
ceived some imaginary wrong from a criminal pal. 

And thus our young men are constantly instructed in the rights of 
the unwritten law and encouraged in the manly art of self defense dur- 
ing a drunken brawl. And worse than all we read such stuff, we allow 
it to be a part of our fireside literature; we permit family discussions as 
to whether the culprit should be hung or not; we work ourselves up to 
a point of appreciating crime when it is committed as an act of ven- 
geance. We do all of this and and then we wonder at the present con- 
dition of affairs. We have swung so far away from old fashioned puri- 
tanism that sometime we may see the error of our liberal ideas. Vice 
is supposed to be segregated, but we learn of all the intricacies of the 
same in the newspaper which is read at our breakfast table. The most 
offensive journals give a " funny department" for our children and we 
buy this with the rest of the filth thrown in. 

In the reports of this particular trial, in which a young degenerate 
had taken the law into his own hands and had committed murder, it 
was astonishing how much sympathy was demanded for him because 



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302 THE CLINIQUE. 

he had defended, as he supposed, the honor of a woman who had little 
to spare; her picture was served to us daily, each time in a different 
pose; the details of her dirty life were given in verbose and extravagant 
language; ministers of the " gospel character" were constantly giving 
their interviews as to the right and the wrong of the vile escapade; 
some of these gentlemen of the cloth even became special correspond- 
ents on this case, and were hired to flaunt their views in this regard in 
the despicable yellow sheets; lawyers who never had a case in their life 
gave their opinions ad libitum; spinsters gave volumes of interviews 
on the "how" to bring up children and keep them unsullied in char- 
acter, and the most, of these remarks were accentuated by their own 
pictures in evening dress. The avidity with which "nearly" every- 
one devoured these dirty details was only excelled by the emphasis of 
the opinions rendered in all private concourse as to the guilt of the 
criminal. And still we call ourselves a Christian nation. 

Health demands sobriety of life and even if it is a physician's part to 
■deal only with physical ills, he is obliged to look at the mental and so- 
cial relation to disease. The mind has much to do with the extreme 
of disease, even though it may not always be the direct cause; mental 
factors however are altogether too prevalent in present day physical de- 
bility. The gait we are going is playing havoc with the sound mind 
which should protect the sound body; this constant " round of pleas- 
ure" added often to an extreme amount of work is showing its effect on 
many a man and woman whose heads have been turned by the oppor- 
tunities of prosperity. We shall surely view the wreck later on unless 
there is a slowing up before long. Our cases of insanity areincreasing; 
the specific cause of general paresis is receiving much encouragement 
by this high tension life, and more men than we can estimate by their 
high pressure business methods and their extravagant and debasing in- 
dulgences on the side are laying the foundations of a positive business 
and physical failure later. 

It is the moral question, however, that underlies; our future as a 
community and as a nation depends upon this; we cannot long en- 
dure the license of prosperity and not meet a decadence as a sequence. 
If our newspapers are filled with the reports of crime, if the details of 
the under- world are ever before us, if the billboards are covered with 
lascivious suggestions, and if the saloon and the concert hall are allowed 
to prey upon the innocence of our children, how long will it be before 
we reap the inevitable reward of such toleration. The worst offenders 
in public depravity today are those possessed with extreme wealth. 
Someone has said that a million dollars cannot be honestly made; this 



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THE CLIN I QUE. 303 

may not be true, but it is becoming self-evident that it can seldom be 
Tionestly or decently employed by the second and third geueration. It is 
in this class we find the acquired degeneracy and it is against these that 
our middle class need protection. Certainly they should not be upheld 
by the law's delinquency, nor should they be tolerated by decent society. 

H. v. H. 



M>otiztu$. 



REMARKS ON CERTAIN SYMPTOMS OF NASAL SINUS DISEASE 
WHICH MAY SIMULATE INTRACRANIAL LESIONS.* 

H. MANNING FISH, M. D., CHICAGO, ILL. 

During the past few years there have appeared in the literature sev- 
eral cases of brain tumors, that, it was claimed,, were cured by this or 
that form of treatment. The clinical symptoms, cephalalgia, vertigo, 
vomiting and optic neuritis had been present, an unfavorable prognosis 
has been given, and yet, in the course of time the acute symptdms sub- 
sided and, with the exception of the optic neuritis that usually termin- 
ated in partial or complete blindness, the patient made a complete re- 
•covery. 

In one case, by Williams, examined by several neurologists who had 
given an unfavorable prognosis, there was complete recovery including 
•even the vision, and the patient, a school teacher, continued to follow 
her vocation for years. 

These reportsd cures of brain tumor, together with the cases in which 
it is claimed the growth of the tumor had been arrested, are open to the 
criticism of a possible mistake in diagnosis ; there may not have been 
any tumor present at all, and this question, of a wrong diagnosis, ceases 
to be hypothetical in those cases at least that have come to an autopsy 
and failed to show the looked-for tumor. 

An explanation for these obscure cases, the negative autopsies, and 
the cases that recover, has been sought for by various authors. Many 
cases have been attributed to a syphilitic lesion, but Nonne, Dianoux 
and others hold that in a case with a negative history it is a mistake to 
conblude that it was specific on the sole ground of recovery after anti- 

*Read by request before the Chicago Homeopathic Medical Society, April 19th, 1907. 



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304 THE CLINIQUE. 

specific treatment. These men acknowledge that as yet there is no 
satisfactory explanation for many of these cases. 

Several authors express the opinion that there must be some, as yet 
unknown pathological process that can cause the above symptoms. 

I have studied many of these cases and judging from their clinical 
course and symptoms, I am of the opinion that some of them at least 
were unrecognized cases of an affection of the nasal accessory • sinuses : 
a lesion capable of causing the phenomena usual to brain tumor, viz. : 
vertigo, vomiting, cephalalgia and optic neuritis. Vertigo, or dizziness, 
appearing either occasionally or in frequent attacks, is an early and 
very common symptom of accessory sinus disease. It has been noted in 
scores of reported cases and is mentioned by every author of note who 
has studied this condition. 

Vomiting is a symptom of sinus disease that has been mentioned by 
but few authors De Lapersonne, Craig, Kocher, Borthen, Schaeffer and 
one or two others, these cases do not include the many fatal cases of 
meningitis. In a personal case referred by Dr. M. E. Hincks of New 
Orleans, an intense frontal pain and frequent vomiting of several days* 
duration ceased at once $ifter I probed the fronto-nasal canal. 

Cephalalgia is a so well-known symptom of sinus disease that it needs 
only to be mentioned. These headaches are of every description from 
a continual dull heavy feeling to the most excruciating pain, the latter 
usually paroxysmal in character. In chronic sinus disease the patient 
may suffer for days or weeks at a time and then complete relief may ap- 
pear, in some cases suddenly, which is doubtless due to a spontaneous 
drainage of some cavity. 

Optic neuritis, either intra or retro-ocular, as well as hemorrhagic 
neuroretinitis can also result from an affection of the accessory sinuses, 
either the frontal, ethmoidal, sphenoidal, or maxillary. The neuritis 
may cause but little reduction in sight, or the vision may be rapidly 
and completely lost. Optic neuritis due to accessory sinus disease has 
been reported by but a comparatively few men, the sum total of cases 
by American writers can nearly be counted on your fingers. In a per- 
sonal case referred to me by Dr. Brosnan of New Orleans, the vision in 
each eye was reduced to counting fingers. History of influenza, vert- 
igo, headache and purulent nasal discharge. Sole therapy probing and 
syringing the sinuses, brought about a cure in about three weeks' time. 

The following case was referred by the president of a charitable or- 
ganization in New York City. The patient, a woman, had a history of 
severe head pain, vertigo, double optic neuritis; the left eye blind for 
several months, the right had bare light perception. She has been ex- 



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THE CLINIQUE. 305 

amined by many specialists, neurologists, ophthalmologists, and rhin- 
ologists and all said she had a brain lesion. During several days she 
hesitated to allow me to operate, during which time the right eye also 
lost all light perception. Removal of the middle turbinate revealed a 
necrotic condition of the posterior ethmoidal and sphenoidal cells due 
to a sarcoma. The drainage of these cells restored the vision to count- 
ing fingers at the end of a week, when I was called away and did not 
see the patient again. This case is somewhat similar to one reported 
by Prof, de Lapersonne, in which a sudden reduction of vision to count- 
ing fingers was caused by the fungus masses of a sarcoma in the sphe- 
noidal sinus blocking up its meatus. In my case opening the sphe- 
noidal sinus improved the vision as mentioned above. 

The causes of optic neuritis are many and the list is increasing in 
number from year to year. One author, Cheatham, gives some 44 
different etiological factors whose very multiplicity only shows that we 
are still at sea in this regard. Although he does not mention sinus 
disease, except by the general term "nasal disease," this one cause 
alone embraces many of the causes that he mentions, for instance the 
infectious diseases, as in my opinion the pathogenesis of infectious optic 
neuritis is that it is secondary to a sinus affection, and the reports of the 
pathological anatomists, who have studied the sinuses at the autopsy, 
support me in this contention by showing how frequently the sinuses 
are involved. I know that when I claim that sinus disease is one of 
the most frequent causes of optic neuritis I am at variance with all the 
authorities. But have they suspected this causal relationship and even 
in the exceptional cases, where sinus disease was thought of, were the 
sinuses always properly examined? I refer to the frequent mistake of 
excluding a disease of the sinuses owing to an absence of a purulent 
secretion in the nostrils. 

The following case was related to me last year by a man who does not 
believe that sinus disease is a frequent cause of optic neuritis. A man's 
vision was greatly reduced in each eye on account of optic neuritis. 
The upper nostrils were full of pus and polypi, but the doctor re- 
marked, " I do not think it is due to sinus disease as the man is a 
drinker and smoker." The sinuses in this case could drain spontan- 
eously, as they often do, and the vision be fully or completely restored, 
or the optic neuritis might end in blindness. The proper treatment of 
the sinuses should have restored the vision in two or three weeks' time 
as the optic neuritis was recent or acute which condition yields at once 
on draining the sinuses. 

This case could be duly reported as one of toxic amblyopia, alcoholic 



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306 THE CLINIQUE. 

or nicotine, or, if the termination were to be partial blindness and the 
man had a brother who was also similarly afflicted > the case could be 
attributed to hereditary optic neuritis and no one would question the 
diagnosis. I submit this question to your consideration. Is the man, 
who never had a case of any ocular lesion due to sinus disease, capable 
- of giving an opinion ? 

In regard to intracranial pressure and the operations for its relief. 
Authentic cases have been reported where both lumbar puncture and 
craniectomy were followed by immediate relief of the symptoms and 
restoration of vision. Some of these cases however have had recur- 
rences and the operation had to be repeated again and again. On the 
other hand there are instances where the vision was not improved by 
either operation. 

Dianoux speaks of a case where lumbar puncture was performed 
several times, followed later by a craniectomy for relief of intracranial 
pressure due to a " brain tumor, " but at the autopsy no tumor could be 
found. 

Are not these operations, however, directed towards the relief of a 
symptom ; in other words, is not the intracranial pressure itself but the 
result of some pathological process, as a tumor or any other lesion that 
could cause a disturbance in the intracranial circulation ? The vascular 
system of the orbit and the nasal sinuses has anastomosis with the 
meningeal vessels and sends arterioles into the brain substance. An 
irritation of the trigeminal filaments by a sinus disease induces a vaso- 
motor disturbance in this immediate region through a reflex involve- 
ment of the sympathetic : that is my explanation for the various ocular 
lesions that result from sinus disease. The evidences of a disturbance 
in the circulation due to a sinuitis are shown in the nostril either by a 
turgescence, a clear serous secretion, or by a hemorrhage ; in the orbit 
they may present retro-ocular edema, chemosis, choked disc, retinal 
hemorrhages, retro-ocular neuritis, etc. All these lesions I have seen 
to be dependent upon a sinus disease in my own cases. On a priori 
grounds I am of the opinion that a circulatory disturbance can also result 
in the remaining portion of the vascular region under consideration i. e. 
within the cranium ; in other words, not only a serous meningitis but 
an intracranial pressure as well may result from an affection of the 
sinuses. 

I have looked up in the original many of these cases of pseudo-brain 
tumor, and although an accessory sinus disease can account for many 
of the various symptoms, this condition has never once been thought 
of. I will briefly refer to a case reported by Engelhardt. The patient, 



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THE CLIN I QUE. 307 

a young woman, first visited an eye clinic from which she was trans- 
ferred to the nervous clinic with the diagnosis of tumor cerebri. Blind- 
ness appeared early. She suffered the most frightful pains for weeks, 
and later there was a long interval of relief when she returned to her 
home. On the reappearance of the cephalalgia she again came to the 
hospital where she died after weeks of frightful torture. The case was 
written up, the tumor was duly located, everything was ready for pub- 
lication as soon as the diagnosis was confirmed at the autopsy, which 
however failed to show any tumor. In casting about for some morbid 
process that would suit the case, a diagnosis of anemia was determined 
upon and the several phenomena that anemia would not account for 
were attributed to " hysteria," that ever present help in time of trouble. 

This patient's chlorosis or anemia had not been such as to attract any 
attention during life; and as she died of slow starvation, naturally the 
brain and other organs showed anemia. There was one significant 
symptom, however, that they all overlooked and that was, a complete 
anosmia or loss of the sense of smell. This was the first entry made in 
the case record and it was noted throughout the entire clinical course. 
This symptom should have pointed at once to the ethmodial cells; 
Watson in 1875 called attention to this symptom of sinus disease; it 
has been noted by many sinus men; I have restored the sense of smell 
by treating the sinuses. This symptom, if looked for by the ophthal- 
mologist, would often help to lead to the correct diagnosis. 

The following are the points I wish to emphasize: (1) Many of the 
symptoms commont o a cerebral tumor as vomiting, vertigo, cephalalgia, 
optic neuritis, are also symptoms of accessory sinus disease. (2) A 
typical clinical picture of tumor cerebri does not necessarily prove the 
presence of a tumor. (3) An absence of a nasal secretion does not ex- 
clude a sinus disease. 

FIRST DISCUSSION OF PAPER BY DR. FISH. 

Dr. C. J. Swan. — In discussing such a paper as that of Dr. Fish, one 
should have had notification in time to have made preparation worthy 
of such a subject. That sinus disease sometimes simulates brain tumor 
in some of its most important symptoms is not a debatable proposition. 
There is no doubt that there are occasions in which empyema of one or 
more of the accessory nasal sinuses may give rise to symptoms almost 
pathognomonic of brain tumor; that is to say, with sinus empyema, we 
may have cephalalgia, nausea, vomiting and optic neuritis with possibly 
some other additional symptoms, usually thought to go with brain 
tumor. 



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3 o8 THE CLINIQUE. 

That sinus disease frequently, or in any considerable proportion of 
the total number of cases having well defined symptoms of brain tumor, 
is the cause of these symptoms, I would certainly question. One will 
invariably turn to one's own clinical experience in deciding such a 
question as this and especially where there are so few statistics to be 
had. 

In my own experience which includes the examination of about ten 
thousand eye cases, clinical and private, I have seen possibly a dozen 
cases of choked disc. One of these cases was due to sinus disease. All 
the rest, so far as I can remember, were proven by autopsies or other 
means, to be due to other causes than sinus disease. Thus it will be 
seen that apparently choked disc itself is rare and that sinus disease, as 
a cause, is infrequent. However, that does not detract from the value 
of the recognition of the fact that choked disc may be caused by sinus 
disease; that is to say, by sinus empyema, as I very much doubt 
whether it can be caused by a sinus blocked and filled with serum or 
mucus. 

Attempts to probe the sinuses through the natural openings without 
the removal of the middle turbinal, I believe to be in nearly all cases 
productive of more harm than good. Sinus disease has been recog- 
nized for a great many years as one of the etiological factors in choked 
disc, and Max Knies, in a work published in 1894, lays some stress 
upon this. DeSchweinitz in a recent work, and Posey and Spiller, still 
more recently give sinus disease as a cause of choked disc. 

SECOND DISCUSSION. 

C. Gurnee Fellows, M. D. — I am very willing to admit that the 
various sinuses are the cause of ocular symptoms, but I am not ready to 
admit that the medical world has been wrong in its diagnosis of brain 
diseases indefinitely in the past for the want of an absolutely positive 
diagnosis. The subject of inflammation of the sinuses has been grow- 
ing in importance for some time, and all of us have had more or less 
experience along that line. I can admit that some brain symptoms 
may have arisen that have been confounded with inflammations of the 
sinuses, and I think that the distribution of the knowledge upon this 
subject is of value. On the other hand, I do not think that without a 
diagnosis being made there is any more reason for operating upon the 
various sinuses than there is upon the brain. 

I find that there are physicians who make mistakes in diagnosis; for 
instance, I had a man in a day or two ago who was just out of the 
hospital after a frontal sinus operation which afforded him absolutely 



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THE CLINIQUE. 309 

no relief, but I believe that this was a mistaken diagnosis and the wrong 
sinus attacked, for he has polypi within his nose which spring from 
the middle turbinated and, as you know, the middle turbinated is part 
of the ethmoid bone, which, in my opinion, should have been opened 
first for the relief of pain, even though it was in the frontal region. 
To my way of thinking, this is such an open mistake in diagnosis that 
I see no reason why a mistake should not be made in diagnosis as 
suggested by Dr. Fish. I know that we are all prone to error, mainly 
from a lack of knowledge, for it is impossible to be up-to-date on every 
subject and for my part, I know that I am unable to probe the frontal, 
ethmoidal, and sphenoidal sinuses at will for two reasons ; — in the first 
place it cannot always be done, because of the common deformities 
within the nasal cavity, and many times our patients object to even 
such a simple operative measure, demanding a postponement of such 
treatment until other measures have been followed. To say that each 
one of these must be surgically opened, is claiming too much for the 
importance of these organs. On the other hand, if with all the means 
at our command, — inspection, trans-illumination, posture, etc., we are 
only able to make a questionable diagnosis, then I believe the operative 
exploration is advisable. Many of us as specialists, and many of you 
as physicians, have seen an unusual number of acute cases of sinusitis 
this winter, and we have followed the treatment which was instituted 
years ago, — of applying cocaine to the region of the natural opening, and 
now with the addition of adrenalin to the cocaine, we can drain many 
of these cavities without either catheterization or operation, but, like all 
other closed cavities with pent up secretion, they must be opened when 
the occasion demands. 

THIRD DISCUSSION. 

Dr. McBean. — It seems to me there is more truth in Dr. Fish's paper 
than the previous speakers have given the subject credit for. No path- 
ologist denies the elective affinity of certain toxins for certain tissues, 
and every practitioner knows the attraction between the influenza toxin 
and nerve tissue. Toxin formation is not necessarily accompanied by 
pus formation; the germ on a mucous membrane may simply excite a* 
catarrhal secretion, but the toxin will be absorbed just the same and 
will search out the special cells which it favors. Few oculists deny the 
toxin theory of sympathetic ophthalmia: to my mind it seems just as 
reasonable that certain toxins formed in the nasal sinuses may be ab- 
sorbed and set up a neuritis of the optic nerve which has the same 
blood supply. 



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310 THE CLINIQUE. 

* 

We don't know the germ which forms this toxin (if there be one) 
but perhaps the influenza bacillus, under favorable conditions, might 
cause optic neuritis as it is a frequent cause of nasal sinuitis. 

I am treating a patient now for chronic sinuitis in whom I have re- 
moved the middle turbinals and many polypi. She had had frequent 
attacks of blindness in the left eye when she could only count fingers, 
accompanied by pain back of the eye. After removing the anterior 
wall of the left sphenoidal sinus under cocaine, I found the cavity filled 
with polypi. I curetted these out and allowed the sinus to fill up with 
granulation tissue." The eye symptoms disappeared at once, and now, 
two months later, they have not returned. I am sorry that there was 
no ophthalmoscopic examination made that I can report in this case. 

Another patient, who came to me recently for an acute frontal sinui- 
tis, was under the care, this spring, of a famous oculist of the old school 
who is so exclusive that he did not even look into the nose during the 
six weeks she was under his care. She had an abundant purulent nasal 
discharge which cleared up nicely, as did her eye symptoms, after I 
catheterized the frontal sinus and washed it out with alphozone solution 
half a dozen times. When men in this country like DeSchweinitz of 
Philadelphia, and Gifford of Omaha, insist on the relation between optic 
neuritis and sinus disease (more especially of the sphenoidal sinus) I 
think it behooves us to keep it in mind, for the loss of all the nasal 
sinuses is nothing to the loss of an eye. 



THE ILLINOIS HOMEOPATHIC MEDICAL ASSOCIATION. 

ADDRESS BY THE SECRETARY, DR. BURTON HASELTINE, BEFORE THE 

CHICAGO HOMEOPATHIC MEDICAL SOCIETY AT ITS MEETING 

APRIL 19TH, 1907. 

Indies and Gentlemen: — Your president has requested me as part of 
this evening's program, to say something regarding our State Society. 
As our annual meeting is only a few weeks off this seems an appropri- 
ate time. 

It has been customary upon like occasions to review the history of 
the Illinois Homeopathic Medical Association and refer to the work it 
has done in furthering the cause of homeopathy and protecting our 
school from the aggression of its enemies. This is an interesting sub- 
ject and one with which most of us are not sufficiently familiar. The 
history of our society is a record of more than fifty years of hard and 



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THE CLINIQUE. 311 

honest work for the promotion of what is thus far the highest form of 
medical practice. It is a history that makes a strong appeal to all of us 
and we cannot for a moment afford to disregard the lessons it has 
taught. The old arguments for homeopathic organization in Illinois 
are still good ones. Our society never had a reason for its existence 
that is not an equally valid reason today. If, therefore, I may seem to 
slight the familiar arguments it is not because they are less potent, but 
because I wish to offer a few thoughts that deal more with the future 
than with the past. 

The Illinois Homeopathic Medical Association has stood and must 
always stand first of all for the principles and practice of homeopathy. 
Without this it has lost its soul and is no better than any other soulless 
corporation. But neither the principles nor the practice of homeop- 
athy can thrive is these days without certain modern conveniences. 
These conveniences, while upholding the principle, it is the function of 
such organizations to supply. For the practice of homeopathy they are 
provided in the wonderfully perfect technique of modern medicine and 
surgery. For the principle they are seen in the repeated confirmations 
resulting from the progress of original research. The principle could 
hardly be alive today had it not been so constantly supported by collat- 
eral investigation. Surely our societies should be instrumental in 
promoting such investigation and in making the results available to all 
their members. 

With changing conditions it is becoming apparent that our organiza- 
tion must henceforth fill a larger place than that of the oldf ashioned medi- 
cal society. It is obvious that the medical profession in future will be 
compelled to concern itself more directly with public affairs than it has 
in the past. This it can effectively do only through the medium of or- 
ganized societies. The medical society first must bring its members 
into closer touch with important civic movements and second it must 
furnish the machinery by which they may direct or modify such move- 
ments. Recognizing this, it is the purpose of our officers each year to 
have upon our program some representative of important institutions, 
non-medical in character and this is undoubtedly a feature that will be 
more fully developed in future years. 

The Society can, when necessary, exercise a very practical influence 
in matters affecting the public welfare. Within the past year it has 
brought about the establishment of a tent colony in Illinois where pa- 
tients may have the benefit of homeopathic treatment. With the sup- 
port of the profession it is believed that this institution will exert a 
wide influence not only in direct benefit to its patrons but in the dis- 
semination of valuable information to the public. 



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312 THE CLINIQUE. 

In these practical days a medical society if it would prosper must of- 
fer a material benefit to its individual members and this the Illinois 
Association is arranging to do in a very definite way. Already in its 
official organ, The Cunique, it offers a financial return fully equal to 
the cost of membership. By the insurance plan to be submitted at the 
next annual meeting it will give to its members the benefit of protection 
against unjust malpractice suits. With this plan successfully estab- 
lished it will be nothing less than folly for any doctor eligible for mem- 
bership to remain outside. 

If the limitations of my subject are sufficiently elastic I would like to 
say something just here as to the future of the Illinois, Homeopathic 
Medical Society. We have a situation in Illinois absolutely different 
from any other state. In Chicago we have the undisputed medical 
center not only of Illinois but of many surrounding states. In Chicago 
the homeopathic school has some of its greatest educational and property 
interests. It has clinical material in abundance and teachers of world 
wide reputation. We have a society which is financially and numeri- 
cally one of the strongest in the country, amply able to extend its hospi- 
tality to the large number of outside physicians who, I believe, are very 
willing to accept it. In sister states within a radius of two hundred 
miles from Chicago are more homeopathic physicians than in all of 
Illinois. These physicians naturally regard Chicago ^s their medical 
center and look upon its institutions as peculiarly their own. A large 
majority of them, would, I believe, welcome an opportunity to meet 
with us once a year, to take part in our program and help with the 
work we are doing. They need us and we need them. It only re- 
quires a proper initiative to bring this large number of homeopathic 
physicians into the closer relationship where they naturally belong. 
This initiative it is the province of our Society to furnish and it should, 
in my judgment, take such action at its approaching session. Techni- 
cal questions and minor difficulties will no doubt arise, but as I .study 
the medical horoscope a great central homeopathic society is coming 
and it is coming very soon. 



THE ROCK RIVER INSTITUTE OF HOMEOPATHY. 

The eighty-ninth quarterly session of this association convened at 
the Whiteside Hotel, Morrison, 111., April 4, 1907. The meeting was 
called to order at 11:30 a. m., by President E. A. Sickels, of Dixon, 
111. The following members responded on roll call: Drs. Blackman, 



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THE CLINIQUE. 313 

Bushee, Blunt, W. I. Carolus, Pinley, Gordon, Gray, Gruber, Hazelton, 
Lanning, Lowell, Martin, Scott, Sickels, Skinner, Snavely, Story. 
Minutes of the last meeting were read and approved. 

It was moved and carried that arrangements for a July meeting be 
left to the Executive Committee and that the October meeting be held 
at Clinton, Iowa. Society then adjourned for dinner. On reconven- 
ing at 1:30 p. m., the program printed in our last issue was carried out. 

The papers were ably written and contained many valuable thoughts 
and suggestions. The discussions which ensued were spirited and in- 
structive, bringing out much of practical worth gained from personal 
experience and research. 

The continued interest manifested in our meetings is very gratifying, 
the large attendance at this one showing that our members appreciate 
the benefits to be derived from frequent association and participation in 
the consideration of timely topics and professional problems. Society 
adjourned. 

E. A. Sickels, Pres. 
A. W. Blunt, Secy. 



KENTUCKY STATE HOMEOPATHIC MEDICAL SOCIETY. 

Dear Doctor. — The coming session of the Kentucky State Homeo- 
pathic Society is to be devoted especially to the consideration of 
Homeopathic Materia Medica and Therapeutics. 

We believe in so doing we can best help the cause of our school of 
medicine and at the same time promote the best interests of our fel- 
lows. 

We believe that the law which Hahnemann promulgated is worthy 
of the very earnest consideration of medical men, and its application 
the particular duty of the professed homeopath. 

The object of our president is to drive these salient facts home to 
those who may attend the coming session. * 

Can we prevail upon you to help us in our present enterprise ; will 
you contribute an essay for the occasion? You are distinguished 
among homeopaths, your influence is potent. 

Kindly favor me with your reply, 

Sincerely yours, 

A. L. Babendreier, 
Chairman Bureau Materia Medica. 



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3H THE CLINIQUB. 

THE NEBRASKA HOMEOPATHIC STATE ASSOCIATION. 

The annual meeting of this society will be held at the Linden Hotel, 
Lincoln, Nebraska, May 21 and 22. Unusual efforts have been made 
to get out a large attendance and it is quite evident that this object will 
be attained. Several physicians from out of town have' been invited 
and will probably attend. This is the home of the Dr. Benj. F. 
Bailey Sanitarium and of course the genial and enterprising doctor lives 
in the same town. We hear that he is to entertain the members at a 
banquet in the evening of the 21st. 



THE CHICAGO HOMEOPATHIC MEDICAL SOCIETY. 

The Chicago Homeopathic Medical Society held its 14th annual 
meeting at the Northwestern University Building, April 19th, 1907. 
There was to have been a reception for Dr. E. B. Hooker, but owing to 
his illness, a regular meeting was held. Dr. H. Manning Fish, form- 
erly a demonstrator in Rathe's Clinic in the University of Vienna, read 
by request a paper which is published in full in this number. Drs. 
Haseltine and Hanks also made short addresses on society subjects. 
The following officers were elected for the ensuing year : 
Pres. Dr. Edward Malcolm Bruce. 
Vice Pres, Dr. Kate I. Graves. 
Secy. Dr. George Martin McBean. 
Treas. Dr. L. A. Shultz. 
The society then adjourned until October. 

G. M. McBean. 



EASTERN ILLINOIS HOMEOPATHIC MEDICAL ASSOCIATION. 

The Eastern Illinois Homeopathic Medical association held its regu- 
lar semi-annual meeting in Charleston, 111., on April 10th. An ad- 
dress, dealing with matters of general interest to the profession was 
given by the president, Dr. Wilbur N. Linn of Oakland. Dr. S. W. 
Johnson of Sullivan was elected secretary pro tern. 

The meeting was devoted chiefly to clinical discussions and cases 
were reported by Drs. Welker of Matoon, Green of Charleston, Starr of 
Charleston, Ewing of Tuscola and Boaz of Matoon. Dr. Burton Hasel- 
tine of Chicago, read a paper on Obscure Mastoid Conditions. 

The following officers were elected: Charles Boaz, president; S. W. 



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THE CLINIQUE. 315 

Johnson, secretary; and J. Ewing, treasurer. In the evening a ban- 
quet was given at the Charleston House and Dr. Nathan Starr presided. 
The principle subjects discussed were medical legislation and organiza- 
tion, much interest being manifested in the work being done by the 
Illinois Homeopathic Medical Association. 



THE MISSOURI INSTITUTE OF HOMEOPATHY. 

This flourishing society of the west held an enthusiastic meeting 
April 23, 24, and 25 at the Midland Hotel, Kansas City, Mo., under 
the presidency of Dr. Geo. A. Mellies, of St. Louis. The editor of 
The Clinique enjoyed the privilege of being present and taking part 
in the program. The physicians in this part of the county are up to 
date and earnest in their work; they are not alone conversant with the 
truths of homeopathy, but they are alive to all scientific advances. 
For that reason the meeting was wide-awake and interesting. Time 
was given to every paper for thorough discussion, and all the papers 
were short and to the point. Indeed every society might well pattern 
after the Kansas City meeting. 

The election for the next year resulted in the election of Dr. F. M. 
Martin, Mayville, Mo., president, and Dr. McClay Lyon, Kansas City, 
Mo. , secretary. The next meeting will be held at St. Louis. 



(&atvzspan&mtz. 



Hot Springs, Ark., April 29, 1907. 
Dr. H. V. H albert, Chicago, 111. 

Dear Doctor. — Hot Springs is in the field for the Institute Meeting of 
1908. We can furnish good accommodations for the organization, all 
under one roof, and can give better rates than any hotel at which we 
have been, for the last seven or eight years. Also furnish good rail- 
road facilities. 

We have an ideal climate here during the first few weeks in June. 
We need the influence of the Institute in the southwest, and each and 
every Institute member should come to Hot Springs and see what the 
U. S. government has done in developing the Hot Springs, and to learn 



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316 THE CLINIQUE. 

by seeing that the Hot Springs of Arkansas are the greatest curative 
springs in the world. 

We will be prepared to present the invitation from Hot Springs in 
detail at the Jamestown meeting and ask your earnest support. Please 
look out for Hot Springs interests in your section, and we will consider 
it a personal favor. We would be pleased to hear from you. 

Yours truly, 

Dr. W. O. Forbes, 

Sec'y Local Committee. 



April 23, 1907. 
Dr. H. V. Halbert, Chicago. 

Dear Doctor: Please make following announcement of rates to 
Jamestown Exposition and the American Institute in your next issue of 
the Clinique: 

15-Day ticket — One fare plus $2.25 for round trip. 
60- Day ticket — One and one-third fare plus 25 cents for round trip. 
Season ticket— 80% of double first class fare, plus 25 cents for round 
trip. 
Tickets on sale April 26th to November 15th, 1907. 
Stop-over and change of returning route, allowed on 60-day and sea- 
son tickets. For particulars regarding same, apply to your selling 
agent. 

Sincerely yours, 

W. O. Forbes, 
Chairman Transportation Committee. 



jews Items and fgersfltmls. 



Dr. J. F. Clement of Berlin, Wis., has lately been attending clinics at 
Hahnemann Hospital. 

Dr. F. E. Pierce, of Earlritte, 111., will take a month's rest and travel 
through the southwest. 

Dr. Emma G. Hollo way, of North Manchester, lnd., was one of the 
recent visitors at Hahnemann clinics. 

Mr. Theodore D. Buhl, president of Parke, Davis & Co., of Detroit, 
Mich., died suddenly Sunday, April 7. 

Dr. A. E. Conrad, of Cherokee, Iowa, spent a week during April at- 
tending clinics at Hahnemann College. 

Do not forget the clinical course given at Hahnemann Medical Col- 
lege this month. It is too good to miss. 



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THE CLINIQUE. 317 

Dr. N. P. Smith of Paris, 111., has been in Chicago for. the last two 
weeks. 

Dr. and Mrs. M. H. Deffenbaugh, of Norman, Nebraska, are rejoic- 
ing over the arrival of a son about a month ago. 

The Medical Forum says that Hammond, Ind., a city of over 30,000. 
offers a good opening for homeopathic physicians. 

A doctor, over 30 years old and married, is wanted at Milltown, Polk 
county, Wis. ; also a drug store. For any information apply to Mary 
Sorenson, M. D. 

Wanted, a homeopathic physician to locate in a village of 2,000 people 
in northern Wisconsin. For further particulars write Dr. W. F. Aus- 
tria, Antigo, Wis. 

Dr. Chas. E. Kahlke made a short visit to Springfield early in April in 
the interests of the educational committee of the Illinois Homeopathic 
Medical Association. 

Practice for sale — $3,500-^4,000 per year — in strongly homeopathic 
community of 2,000 inhabitants. Good schools, good society. North- 
ern Wisconsin. K., Clinique. 

Dr. Joseph Lewis of Milwaukee is recovering from a long run of ty- 
phoid fever which was preceded by an attack of appendicitis. He has 
been in the hospital since January 1st. 

Dr. Alden E. Smith of Freeport, 111., has been invited to present a 
paper on the subject of Tent Colony work in our state at the coming 
meeting of the American Institute of Homeopathy. 

Dr. Mary Wells Childs of Spokane, Wash., although retired from ac- 
tive practice still retains a lively interest in medical affairs as shown by 
a recent visit to the eye and ear clinics of Chicago. 

Dr. O. L. Smith, of Lexington, Ky., was operated on at Hahnemann 
Hospital, Chicago, for the removal of a large renal calculus. We are 
glad to report that Dr. Smith is rapidly convalescing. 

Dr. Wilfred H. Gardner, of Bloomington, has severed his partnership 
with Dr. G. B. Kelso and gone to Europe for special study in medicine 
and surgery. Dr. Midgley forms a partnership with Dr. Kelso. 

Dr. C. H. Vilas made one of his too short visits to Chicago, April 
26th and 27th. Dr. Vilas has seen about every large hospital in the 
world and, from present indications, is going to see them all again. 

Dr. I. O. Denman, of Charleston, 111., who is touring Europe with his 
family writes from Paris that he finds the attractions of that city fully 
equal to his expectations but the clinics in some respects disappoint him. 



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3 i8 THE CLINIQUE. 

We are glad to know that Dr. C. E. Sawyer, of Marion, Ohio, has 
nearly recovered from his attack of neuritis. Dr. Sawyer has done 
heroic work for sound homeopathy and we are glad to know of his re- 
covery. 

Dr. A. P. Williamson, Superintendent Southern California State 
Hospital, at Patton, San Barnardino, Co., California, offers an appointt 
ment for third assistant physician. This seems like an excellen- 
opportunity. 

The program of the Gynecological Bureau for the state meeting this 
year includes papers by Dr. C. B- Kinyon of Ann Arbor, Mich., and 
Drs. Becker and Titzell of the Homeopathic department of the Univer- 
sity of Iowa. 

It was very unfortunate that Dr. Edward Beecher Hooker was unable, 
on account of sickness, to keep his Chicago and other appointments 
announced in last number of the Clinique. We are very glad, however, 
to know that the doctor is much better. 

Don't forget the 63rd annual meeting of the American Institute of 
Homeopathy, at the Jamestown Exposition, June 17-22, 1907. See ad- 
vertisement for rates, or apply to Allen M. Nye, Northwestern Passen- 
ger Agent, Big Four and C. & O. Rys., No. 238 Clark Street, Chicago, 

$3,000 residence, $2,000 office outfit and $2,000 practice for the price 
of the residence, and on easy terms, in a town of 3,500. Railroad and 
electric line. The best location for a homeopath in Ohio. None here 
and none closer than ten miles. Death of my husband the cause for 
selling. S^ Clinique. 

All arrangements have been completed for a special train of elegant 
Pullman sleepers and dining car to run through to the Jamestown Expo- 
sition for the exclusive use of members and their friends, who may wish 
to attend the 63d annual meeting in June. Make your sleeping car 
reservations early in order that sufficient accommodations may be pro- 
vided. 

The department of pediatrics of the State Society which reports 
Thursday afternoon, May 16th will contain an address by Mr. A. M. 
Thurston, Chief Probation Officer of the Juvenile Court of Chicago. 
Mr. Thurston will discuss the management of delinquent boys. It is 
expected that this will be one of the most interesting features of the 
program. 

Accommodations for the meeting of our State Society at the Sherman 
House this year are exceptionally good. The main hall on the second 
floor is easily accessible and free from noise. Smaller rooms are con- 



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SYR. HYPOPHOS. CO. . FELLOWS 

Contains the Fm«*t*a1 Elements of the Animal Organization — Potash and 
Lime; 

The Oxidising Agents — Iron and Manganese ; 

The Tonics — Quinine and Strychnine ; (each fluid drachm contains the equiv- 
alent of i -64th grain of pure Strychnine.) 

And the Vitalizing Constituent — Phosphorus ; the whole combined in the 
form of a Syrup with a Slightly Alkaline Reaction . 

It Differs in its Effects from all Analogous Preparations; and it possesses 
the important properties of being pleasant to the taste, easily borne by 
the stomach, and harmless under prolonged use. 

It has Gained a Wide Reputation, particularly in the treatment of Chronic 
Bronchitis, and other affections of the respiratory organs. It has also 
been employed with much success in various nervous and debilitating 
diseases. 

Its Curative Power is largely attributable to its stimulent, tonic, and nutritive 
properties, by means of which the energy of the system is recruited. 

Its Action is Prompt; it stimulates the appetite and the digestion, it promotes 
assimilation, and it enters directly into the circulation with the food pro- 
ducts. 

The prescribed d»*se produces a feeling of buoyancy, and removes depression 
and melancholy ; hence the preparation is of great value in the treat- 
ment of mental and nervous affections. From the f *ct, also, that it exerts 
a tonic influence, and induces a healthy flow of the secretions, its use is 
indicated in a wide range of diseases. 



NOTICE-CAUTION. 

The success of Fellows' Syrup of Hypophosphites has tempted certain 
persons to offer imitations of it for sale. Mr. Fellows, who has examined 
samples of several of these finds that no two of them are identical, and that 
all of them differ from the original in composition, in freedom from acid re- 
action, in susceptibility to the effects of oxygen when exposed to light or 
heat, In the property of retaining the strychnine in solution, and in the me- 
dicinal effects. 

As these cheap and inefficient substitutes are frequently dispensed in- 
stead of the genuine preparation, physicians are earnestly requested when 
prescribing the Syrup, to write " Syr. Hypophos. Fellows." 

As a further precaution, it is advisable that the Syrup should be ordered 
in the original bottles; the distinguishing marks which the bottles (and the 
wrappers surrounding them ) bear, can then be examined, and the genuine- 
ness — or otherwise — of the contents thereby proved. 



This preparation can be procured at all chemists and druggists, everywhere. 



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319 THE CLINIQUE. 

veniehtly located for special committee meetings. The Sherman House 
being made headquarters it is especially convenient for out of town 
physicians. 

The International Hahnemannian Association, F. W. Patch,M. D., Presi- 
dent, will hold its twenty-seventh annual meeting at the Jamestown Ex- 
position, Norfolk, Va., June 24-25-26. A strong program is promised 
by the chairman of the various bureaus. The time is so arranged that 
the American Institute and this meeting can be taken in on one trip. J. 
B. King, M. D., Secretary. 

On April 24th the executive officers of all the medical societies of 
Illinois met by invitation with the Illinois Board of Health at the Great 
Northern Hotel, Chicago. Important matters concerning medical legis- 
tion and the public health were extensively discussed. It is the plan of 
the board to have similiar conferences in future for the purpose of bring- 
ing about greater harmony of all medical interests in our state. 

For Sale. — Wanted, by a homeopathic physician who is retiring on 
account of illness, a physician with cash to purchase a fine old colonial 
home in a large borough near Philadelphia with twenty surrounding 
towns and thickly populated country. House has every convenience; 
oak timbers; healthy, cheerful, easily heated. Barn, fruit, flowers, box- 
bush hedges, old trees. With this property goes a practice established 
over twenty years — a first class business opportunity. Price $20,000, 
with or without a mortgage of $10,000. Address The Clinique, 141 
Kinzie St., Chicago, 111. 

The Nebraska State Homeopathic Medical Society will meet at the 
Lindell Hotel, Lincoln, Nebraska, May 21, 22 and 23. The officers of 
the society are: President, E. Arthur Carr, M. D., Lincoln; first vice- 
president, H. R. Miner, M. D., Falls City; second vice-president, F. A. 
Marsh, M. D., Seward; corresponding secretary, F. F. Teal, M. D., 
Omaha; recording secretary, F. S. Whitman, M. D., Omaha; treasurer, 
O. S. Wood, M. D., Omaha. The prospects for the meeting are fine. 
An attractive program is being prepared. — The Medical Forum. Dr. 
Halbert, of the Clinique, goes to this meeting to present a paper. 



AMERICAN INSTITUTE OF HOMEOPATHY. 

To the Homeopathic Profession. — With the next session of the Amer- 
ican Institute of Homeopathy drawing near — June 17, 1907 — it seems 
fitting to issue an earnest appeal for every homeopathic physician to 
take an active part in making this sixty-third session a success, not alone 
from a social and numerically-attended standpoint, but also from that of 
the School of Homeopathy. Although the Institute in its more than 
half century of existence has numbered among its members some of the 
best homeopaths that have been in the practice, there have always been 
those who held aloof. This is to be deplored, for the American Insti- 
tute of Homeopathy has ever been in the front rank of progress in mat- 



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Method of Application in Boils, Carbuncles Etc. 

A most useful adjuvant in the treatment of superficial and 
deepseated inflammatory conditions when a local application 
is indicated. 



The Denver Chemical Mfg. Co. 



DENVER 

CHICAGO 

SAN FRANCISCO 



NEW YORK 

LONDON 



SYDNEY 

MONTREAL 

BUENOS AIRES 



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320 THE CLINIQUE. 

ters of medicine and surgery; it is neither narrow nor dogmatic in its 
tenets, philosophy or practice; it is broad and liberal in an honest and 
homeopathic way; and it extends a hearty welcome to every home- 
opathic physician, promising a fair equivalent for his time, attendance 
and attention. For it stands to reason that the annual mingling of the 
most advanced men and women in the school — the teachers, authors, 
writers, editors, practitioners, and specialists — must make for the better- 
ment of all partakers. And this is true whether that member hails 
from the densely populated city, or from the quieter but nevertheless 
strenuous life in the interior of the state. 

The Institute of Hering, of Farrington, of Helmuth, of Lilienthal, of 
Allen, of Deschere, of Waite, of Dake, of Talbot, of Holcombe, of Saw- 
yer, of Ludlam, of Kinne, of Doughty, of Dudley, and the many other 
famous men and women who have gone before, still lives; it keeps 
abreast of the day. It especially welcomes the younger and newer 
members of the profession who bring the latest and best from the 
schools together with their enthusiasm and younger blood. From all 
parts of the habitable globe came testimony at our Atlantic City sessions 
of the admirable status of homeopathy everywhere. The bureaux and 
allied societies are sending in programs from which it is evident that the 
sessions at Jamestown will be of the highest order; while the efforts of 
the Local Committee in the line of recreation and entertainment, and 
the success of the Exposition management in providing for our comfort 
and habitation all give promise of making this a banner session. The 
details of hotel, railway, and other matters not already communicated in 
the Exposition literature, will be embodied in the official program to be 
mailed at an early date. 

By order of the President, 

Frank Kraft, M. D., 
Secy. American Institute of Homeopathy. 



The following changes* corrections and omissions in the published 
list of committees of the American Institute of Homeopathy are sub- 
mitted : 

Conference with American Medical Association, A. B. Norton, M. 
D., New York, Chairman, with Drs. C E. Walton, J. B. Gregg Cus- 
tis, R. S. Copeland and B. F. Bailey, associates. 

Institute Journal, George Royal, M. D., Des Moines, Chairman, with 
Drs. J. H. McClelland, B. F. Bailey, Chas. E. Kahlke, R. S. Copeland, 
and the Secretary as associates. 

W. A. Paul, M. D., Center Dorchester, Boston, is Chairman of the 
Committee on New Members, vice H. E. Spaulding, M. D., resigned. 

T, H. Carmichael, M. D., Philadelphia, is Chairman of Committee on 
Homeopathic Pharmacopoeia, with J. W. Clapp, M. D., Boston, as 
Secretary. Dr. Chas. Mohr of Philadelphia, continues an active member. 

Chas. E. Walton, M. D., is Chairman of Intercollegiate Committee. 

Frank Kraft, M. D., Secretary. 



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THE CLINIQUE. 

VOL. XXVIII. JUNE, 1907. NO. 6 



(Shighral Articles. 



PRESIDENT'S ADDRESS.* 



MARY E. HANKS, M. D., CHICAGO. 



Mr. President and Men and Women of the State Society: 

It has been so long customary for your presiding officer to address 
the annual meeting that an omission would be a breach of decorum. 
The imperative needs of our school have been so often presented to you 
and the remedies for existing defects so often suggested that I can 
hardly hope to lay claim to originality in what follows. It is good, how- 
ever, lest we forget, to keep before us the things for which we must 
strive. It is also pertinent to examine occasionally the reasons for our 
faith — of which the following seem good to me. 

First — Upholding the truth of our law of similars we have the clini- 
cal history of one hundred and fifty years. These years have seen the 
birth and death of many other systems of medicine and theories of 
cure. But never once has the truth of homeopathy been even crushed 
to earth. 

Second — We have each day our own personal observations which 
convince us of the wonderful dependability of our drugs, even though 
they may be administered .under strange and unfavorable conditions. 
No one can convince us, for instance, that bryonia potentized is a fal- 
lacy. The first exhibition of its wonderful power may have made us 
question whether it was Nature or bryonia. But a hundred such 
demonstrations made us believe that the curative action of bryonia is a 
fact. 

Third — We have the unintentional testimony of the so-called regular 
school. This is accumulating every year. Their specifics are in every 
case acting under the law of similars. Mercury in syphilis, and 

♦Read at the 52nd Annual Meeting of the Illinois State Homeopathic Medical As- 
sociation, May 14, 1907. 



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322 THE CLINIQUE. 

quinine in malaria, which, according to Doctor Frank Billings, are the 
only dependable drugs they have, both act homeopathically as we well 
know. In fact, quinine was to Hahnemann what the falling apple was 
to Newton. The many cases of poisoning resembling malaria, from a 
quinine factory near by made Hahnemann search for the Taw under- 
lying the action of drugs. One of the most interesting and convincing 
studies I have ever made was of comparative therapeutics. It is sur- 
prising to find how many drugs of the old school are employed accord- 
ing to the law of similars. You will find in reading that the " physio- 
logical action" of many of their drugs is repeated almost word for 
word in their " therapeutic uses." The main reasons for their failures 
to appreciate our law, are the crude overdose and lack of knowledge 
and care in selection. They have, in other words, no guide, though 
empiricism has led them accidentally in our direction. But more than 
this, their scientific research is bringing them nearer and nearer a 
demonstration of the truth of homeopathy. The different toxines that 
we must admit are more or less successful are surely similar to our law 
of similars in their action. Recently the allopathic journals, contain 
much concerning the opsonic index. They are greatly interested over 
the " discovery" of a "new" system of cure, while we recognize an 
old friend in a new spring suit. A few days ago in my presence two 
allopathic friends were discussing the practical application of the 
opsonic theory in a case of tuberculosis. Daily injections of well- 
diluted tuberculin (the dilution corresponding about to our 30x) were 
used with marked benefit. I gleefully assured them they were on the 
right road. They were surprised to know that we had been giving a 
thing we called tuberculinum for many years. I was proud to explain 
it to them, though I confess I pitied them a little because of their in- 
fantile development in the knowledge of the great law. Though tuber- 
culin and tuberculinum may not be. exactly the same, there is no doubt 
that their spheres of action are closely related if not identical. 

Fourth — The homeopathic world is watching the great world of 
science with the keenest interest. The accepted theories of the divisi- 
bility of matter surprises even us. In the New York Medical Journal 
of February 10th, 1906, the following occurs: " Within the last half 
dozen years the great progress made in the study of radiant-matter has 
done much to modify our conception of the composition of matter. 
* * * An electron is about one-eight-hundredth of an atom of hy- 
drogen, which was heretofore believed to be the smallest thing. * * * 
It would take two septillion three hundred sextillion of these particles 
to weigh a grain. (In order that you may come nearer an appreciation 



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THE CLINIQUE. 323 

of what that means, I will express it in figures for you; (2,300,000,000- 
000,000,000,000,000), as even with this no mind can realize it). The 
remarkable fact remains that within the atoms of matter reside forces 
of stupendous power, much more energetic than the ordinary physical 
and chemical forces we are familiar with." The writer follows with 
the question " Can we make use of this intra-atomic energy?" Hahne- 
mann answered in the affirmative a hundred and fifty years bofore the 
question was asked, and we have been answering with practical affirma- 
tions ever since. However, science has a long road to travel before it 
arrives at the point that we have reached with some of our attentua- 
tions. 

It is as unnecessary as it is impossible to demonstrate each successive 
step from the administration of the drug to the cure, but we are con- 
stantly accepting in biology, chemistry and physics, facts which we can 
neither demonstrate nor evade. They are necessary to us because they 
form practical working bases. Nor can we define, measure, weigh, nor 
explain the thing we call Life, yet we know it is a fact. 

Homeopathy occupies a unique position in the medical world. Its 
sphere of action is definite, positive, legitimate, but it is not the only 
method of cure. It does not take the place of proper diet, fresh air, 
electricity, the therapeutic light, nor the mechanical nor suggestive 
therapeutics, but it is so benign and friendly that it does its work in 
the presence of these and other adjuvant measures. There are those 
among us who seem to fear that some other method of cure may be dis- 
covered, or that some drug may be proven curative, though not in ac- 
cordance with our law. It has become almost a sacrilege to them to 
consider the medical question in any other phase. The scientific facts 
of today crumble and decay before them if there seems to be even a 
slight discrepancy between the facts and a single line of the Organon. 
It seems to me necessary to recognize that homeopathy is not a creed 
nor a religion any more than is Newton's law of gravity, or the science 
of chemistry and physics. True it is that Hahnemann was a seer, a 
prophet, and the bases of his work was scientific and lofty. The many 
years intervening between, his day and ours have shown amazingly lit- 
tle at variance with the demonstrable scientific truths of .today. But 
we must not deify him, nor rely too much either upon the infallibility 
of Hahnemann, nor upon our present conception of the law he formu- 
lated. And this brings me to another subject that I cannot refrain 
from discussing, and that is the question of toleration and generosity 
in judgment. 

Unless these qualities can be cultivated it will grow more and more 



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324 THE CLINIQUE. 

difficult for the extreme wings of our school to meet on common ground. 
It is not a thing to regret that we have not all developed in the same 
direction. Indeed, it would be as undesirable as it is impossible. 
Each one of us is honestly believing the things that his birth, environ- 
ment, education, and experience compel him to believe, and if we differ 
no harm can result so long as we eliminate personalities and refuse to 
descend to pettiness. In fact, a difference of opinion stimulates 
thought, and thought stimulated insures progress. It is not fair to 
your associate to assume that because he cannot agree with you in his 
methods of work that he is either lazy, dishonest, ignorant, or disloyal. 
He is working according to his experience, which must necessarily have 
differed from yours. He is giving the higher attentuations perhaps 
because, in his experience, he gets better results. You are giving the 
low because your experience leads you in that direction. The import- 
ant point is that you are giving the same drugs according to the same 
indications. This law, underlying your rule of practice, and forming 
the foundation upon which the homeopathic school is built, is certainly 
well enough established to keep the members of our school working 
harmoniously together. It is past argument that our personal beliefs 
and experiences must modify our methods, and it is a waste of time and 
energy to quibble over it, when there remains such important work to 
be done to establish our school in its right place before the world. 

The intolerance sometimes seen among our members is unworthy of 
those who hold the interests of our school uppermost. The man in- 
clined to materialistic doses may laugh at the higher potencies, and 
even deny the existence of such attentuations, and the possibility of 
cure by them. But he should remember that we are no longer think- 
ing in atoms and molecules, but in ions and electrons and radio-activity, 
and everything indicates that the end is not yet. New words will con- 
tinue to appear to express new forms of energy and new divisions of 
matter. Hahnemann's theories are vindicated, — if not all his argu- 
ments for dynamization. And further, our materialistic brother is 
compelled to admit at times that his lower potencies, and perhaps his 
combinations, have not completed his case, and the work is finally 
accomplished by the man who patiently sits down with his repertory 
and selects the similimum which he administers in incomprehensible 
attentuations. 

On the other hand when the strict Hahnemannian is inclined toward 
intolerance, let him remember, first, that if the action of our remedies 
depended upon the absence of all other drugs from the system, we 
would never get results. How many patients do we have who are not 



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THE CLINIQUE. 325 

already drugged with tea, coffee, and tobacco? Nor can we stop here, 
for even our foods contain crude drugs. We have had positive evi- 
dence many times that a patient has taken a large dose of allium cepa 
crude before coming to us, yet we prescribe for him with confidence 
and with good results. When we have completed a meal of nutritious 
and highly approved foods we are filled with various tissue remedies 
combined with real drugs. It would surprise many of us to contem- 
plate these in detail. For instance, our innocent nutritious oft-recom- 
mended cocoa contains in good quantity the drug known as theobromin, 
and represented by the complex chemical formula (C 7 H 8 N 4 O 2 ). As 
though this were not enough, Nature recklessly throws in another 
alkaloid more complicated than theine though resembling it. The ash 
of milk contains potassium, sodium, calcium, magnesia, phosphoric 
anhydride, sulphuric anhydride, and chlorine. When we put a patient 
upon milk diet he is getting not only many drugs but material doses. 
Butter contains nine fatty acids complex in nature, of which stearic 
acid (C 18 H* O 9 ) is a good example. 

The vegetarian eats with his cereals many drugs, as oxide of iron, 
alumina, silicea. The rind of potatoes contain an active poison called 
solanine. And so we may go on indefinitely and show that the active 
principle in almost every fruit, vegetable, and root may be and often is 
extracted and many of them found on our drug store shelves. We eat 
these foods containing drugs and we thrive. We administer our diluted 
drugs in the presence of these different crude drugs and our patient 
survives, yea even recovers health. 

Second, it is the case that comes to us from other schools of practice 
saturated with drugs, in which we get the most brilliant results. These 
are the cases we are certain to report at our society meetings. 

Third, one of the oldest arguments in favor of homeopathy is that if 
a drug is not needed in the system it passes off without harm as an 
inert body. 

Though it is not a thing we like to admit, and though it may indi- 
cate a lack in scientific accuracy, yet we cannot evade the fact that 
cures, real cures, are often accomplished under the influence of drugs 
combined. Indeed, one would hestitate to condemn this absolutely 
especially in the use of the tissue remedies. We find throughout 
nature many substances which are a combination of these elements. 
Our natural waters are a good example. And lastly, in man, the 
crowning work of creation, we find the whole twelve tissue remedies 
combined (not mentioning the many food drugs passing along his ali- 
mentary canal. ) So it would seem that mere man might be forgiven 



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326 THE CUNIQUE. 

lot occasional slips when Dame Nature is guilty of such un-Hahneman- 
nian methods. 

Now, please remember that this is not a plea for combination of rem- 
edies, nor a defense of it. It is not a contention for any potency. It 
is rather a plea for toleration of the man who differs from you. He 
may be honest, even intelligent, and he may be as firm a believer in 
our law of similars as are you. Dogmatism repels, puts up dividing 
lines. Intolerance even leads us to glory in the failure of our col- 
league who differs from us. It takes us away from the highest form of 
ethics into personalities and bickerings. Tolerance and generosity 
bring men together in a frank discussion of their differences. To 
grant freely the right you claim precludes dogmatism, intolerance, and 
Pharisaical habits. 

Organization. — I do not want to bring about unity, cordiality of 
feeling, and co-operation by indulging in doleful prophecies. That 
motive would not be the highest one, but it has for some time been ap- 
parent to many of the foremost workers of our school that we must 
stand shoulder to shoulder and make the most of our latent energy if 
we would preserve our identity as a school. The question of organiza- 
tion is not alone one of desirability, or expediency. It is one of necessity 
and of self-preservation. It is impossible to describe to you in detail 
the army-like organization that is being perfected by the old school. 
They know that power comes through unity. They know that they 
must themselves become amalgamated before they can hope to amal- 
gamate the whole medical profession or accomplish any other great 
work. We would exhibit acumen by imitating their methods or im- 
proving upon them if possible. And unless we desire, Jonah-like, to 
inhabit the whale's belly, without "dry land" sequel, we must organ- 
ize. And this, I am glad to assure you, is gradually being consum- 
mated. 

It is gratifying to see throughout the state local societies springing 
up through the efforts of our organization committee. . Their labor has 
been made arduous by the lack of co-operation and cordial response. 
The hundreds of letters sent out have received but slight recognition. 
Each step accomplished represents much persistent labor. But it has 
been worth while. Our organizations have brought to the front splen- 
did men and women of whose existence we were hardly aware. They 
have been working quietly and alone, upholding in a masterful way 
their belief in homeopathy. Each year we see new faces at our state 
society, and enjoy the benefits derived from added strength. We are 
mutually improved and no busy practitioner can, by himself, get out 



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THE CLINIQUE. 327 

of the ruts into which he must fall. No amount of study can make up 
for the lack of personal contact and exchange of ideas and experiences. 
We hear much complaint these days because we have not been recog- 
nized by the various corporations, and that the lucrative, influential 
positions fall largely to others. The main reason that we lack influ- 
ence with legislative and corporate bodies is due to our want of strength. 
The dominant school is dominant because of its mutuality and its 
organization. What is more natural than that corporate interests 
should employ men who themselves belong to a strong corporation that 
loyally protects and upholds its members in the courts and elsewhere ? 
But the outlook for us is not discouraging. Much has been accom- 
plished in the last five years. An organization should not be judged 
so much by its present status as by its rate of progress. If, in looking 
backward, you note growth and evidences of advancement, you have 
good reason to believe that the future will bring equal or greater results. 

The Tuberculosis Tent Colony. — Another important indication 
of growth and activity is the work accomplished in one brief year by 
our Tent Colony Committee. The Society has great reason to con- 
gratulate itself that this committee is bringing to us plans so practical 
and ideal that, when completed, our state will contain the most beauti- 
ful and the best equipped institution of the kind in this country, if not 
in the whole world. Your committee has characterized itself by extra- 
ordinary zeal, patience and determination, in the face of overwhelming 
discouragements. You may also congratulate yourselves that this com-' 
mittee contained four men who, by stepping into the breach and 
assuming financial and other obligations, saved for the State Society 
both reputation and money. I refrain from further comment, but 
urge you to be present when the Chairman, Doctor J. P. Cobb, makes 
his complete report tomorrow, and I bespeak for this committee the 
appreciation and support that they have many times earned. 

The Question of Reciprocity. — Even if I were master of the 
subject, it could not be discussed in its entirety here, but a few points 
may be in order. There is a . disposition on the part of many physi- 
cians to complain, and indeed, the present conditions do work embar- 
rassments and hardships to those older licentiates who live near state 
lines, or to those who are desirous of moving to other states. At first 
thought the present law seems unnecessary and unjust to these men 
who complied fully with the law when they applied for license. But 
upon going into the question more deeply it is difficult to see where 
our state board of health could show greater leniency to the few with- 
out unfairness to many. Would it be well to lower the requirements 



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328 THE CLINIQUE. 

and the high standards of our state for the accommodation of those who, 
in a few years, will probably discontinue active practice? It is well to 
remember that probably many more would come into our state than 
would go out of it, and with our doors wide open, and our requirements 
lessened, quacks and peddlers, (many of whom would hold diplomas of 
medical schools), would have the opportunity they devoutly wished for. 
These find Chicago, especially, a most desirable field, and few, propor- 
tionately, would leave the state to offset the flood of undesirables who 
would enter. Again, we should remember that our state makes gener- 
ous concessions to the reputable practitioner by allowing a credit of 
five per cent, for each five years the candidate has been in active prac- 
tice. Hence, a practitioner of twenty years receives a credit of twenty 
percent., thus effectively reducing his minimum of seventy-five per 
cent, to fifty-five. This seems eminently fair to the man who has for- 
gotten much of the elemental work, but whose skill and experience 
more than compensate in the practice of his art. If other states would 
follow the example of Illinois in this there would be less reason for 
complaint regarding reciprocity. With many states Illinois now en- 
joys reciprocal relations in the cases of those who have passed the 
required examination. If it were possible for all the states to agree to 
the same requirements, as some urge, an ideal condition would be near 
at hand, but when did all the states in the union agree on any impor- 
tant issue, such as the race question, or questions of finance and law? 
Such a condition of affairs is certainly too far away to be an important 
issue at this meeting. 

Reciprocity, the real thing, is desirable elsewhere as well as between 
states. I mean reciprocity in the broader sense, and as applied to 
smaller affairs. For instance, we have pharmacies that are loyal to the 
physician and protect his interests. They do not cater to layman trade. 
They do not practice medicine without a license by prescribing over 
the counter. They do not fill their windows with placards advertising 
cures or diseases peculiar to the season. In other words, they seem 
still to possess the old-fashioned idea of ethics. All things being equal, 
would it not be desirable for us as physicians to establish reciprocity 
with those pharmacies? Would it not be well to educate both physi- 
cian and pharmacist along this line? 

Education. — And this brings us to other questions of education. 
The function of our State Society has been too narrow and limited. 
We meet annually and listen to many papers on materia medica, prac- 
tice, etc., which, while important and interesting, are repetitions of 
what we heard in our sophomore and junior years in college. We 



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THE CLINIQUE. 329 

transact in a desultory way whatever business is presented. We 
cautiously interest ourselves in a few questions pertaining to public 
welfare, adopt a few resolutions, and go home. 

The sphere of the State Society should be much wider and more im- 
portant. It is a parent organization, with which all county, city, and 
local societies should affiliate and co-operate. The ultimate strength 
of the State Society must depend upon the lesser organizations, and vice 
versa. For so many years our school was on the defensive that it 
seems to overlook the fact, that it has reached the age of accountability 
where it must take the initiative. It should plan attacks instead of re- 
maining quietly behind its bulwarks. Our programs should be 
broadly educative. They should frequently deal in larger issues than 
those treated in our student days. They should place before us sub- 
jects new, that we may not find at home by consulting our library. 
The State Society should attempt great things and the members should 
work together for their accomplishment. Our Tent Villa is a splendid 
step in the right direction. Popular education along certain lines 
should be an important question for discussion at our State Society. 
The work of reproving our drugs, and perfecting our Materia Medica, 
is a matter for interested and concerted action. I would urge that this 
work be pressed with all vigor and haste that is consistent with preci- 
sion. It is our urgent duty to place our Materia Medica upon a flaw- 
less foundation, and then we may court investigation and the actions 
of a critical public. 

The influence of the State Society should not be confined within 
state lines. Chicago being the great clinical center of the middle west 
has enough for its own and to spare. Here again comes in the ques- 
tion of practical reciprocity. Neighboring states are only a few miles 
away and in the sharing of our feast state lines can well be obliterated. 
Our secretary has been working to develop the idea (which is his orig- 
inally) and will no doubt present a plan consistent with our constitu- 
tion and with the spirit of generosity and good fellowship which should 
characterize such an important organization as ours. Health boards 
should not be left alone to deal with questions of public interest. We 
should co-operate with them, or oppose them, if necessary. Whatever 
work is of common interest, such as questions of public health and bet- 
terment, sanitation, desirable or pernicious laws, and many other 
questions, are ours to consider as well as theirs. And if these are 
wisely settled we share also in public recognition of work well done. 
When we have become better educated ourselves through the influence 
of our State Society we can better undertake the task of educating the 
public, which is such an important part of our work. 



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330 THE CLINIQUE. 

Another important function of the State Society is the education of 
the layman mind. The truth about homeopathy can as well be taught 
an intelligent public as can the habits of the tubercle bacillus, the 
horrors of the bubonic plague, or the details about the mosquito that 
carries yellow fever in its sting. This is the day when the layman 
body demands to know. The things thought of as the physician's secrets 
twenty years ago are today in the mouths of babes. 

One means of public education long neglected is the daily press. 
Rarely do we see notices of important or of interesting events pertain- 
ing to our school. Today newspapers are a means of education good 
or bad. We have complained that the columns of the press have not 
been freely opened to us. This may be true to a degree but it is largely 
our own fault. An item of news, or an interesting bit of information 
is eagerly sought, and the public reads nothing with more interest, in 
general, than medical news. How many of your patients and mine dis- 
cussed anxiously the alarmingly hopeless dissertation which appeared a 
year or more ago on pneumonia ? The homeopaths did not at that 
time take the tide at its flood and meet argument with argument, show- 
ing the brilliant results under homeopathic medication. It wonld have 
been such good news to the public that any newspaper would have 
published it thereby saving the lives of those who have since been 
scared to death. Medical matters, however, should be edited by a com- 
petent medical man. The daily press left alone often gives erroneous 
and damaging accounts of medical matters. 

" Mr. So-and-so, died this morning as the result of an operation." 

" Mrs. A. died yesterday from heart failure while taking an electrical 
treatment." 

" Miss X-Y-Z died in Timbuctoo last week. The post mortem re- 
vealed a pair of skates inadvertently dropped into the abdomen during 
an operation." — The need of an editor of medical news is obvious. 

Patent Medicines. — We should earnestly assist in the crusade 
against patent medicines. It seems almost unnecessary to comment 
upon this before a body of intelligent physicians, but so long as doctors 
recommend concoctions without knowing the contents of the same, 
there is something to be said. We cannot educate until we are well in- 
formed ourselves. What mother would administer a soothing syrup if 
she knew the baby were narcotized and could not waken ? What man 
would take repeated doses of headache powders containing coal-tar if 
he knew that the heart muscle is positively weakened by each dose, 
even if caffeine, or some other heart stimulant, overcomes the immedi- 
ate effect. It is difficult to understand why some physicians are still 



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THE CLINIQUE. 331 

recommending the coal-tar products, even though the foremost men of 
the allopathic school are now condemning them as vigorously as they 
recommended them a few years ago. We leave too much to the recom- 
mendations of the commercially inclined druggist and to the men and 
women whose faces are familiar in Peruna and other advertisements. 

One more important subject for public education is that of legacies. 
Our colleges need many things — but we can sum them all up in the 
word money. All else would follow. The most critical could have no 
cause for apology as to our laboratories, dispensary equipments, build- 
ings, etc. Money would even attract a certain quality of loyalty to us. 
Many of you have on your list names that represent wealth. Look out 
for legacies, and do not be modest in your requests. 

Were I to take a text for my final exhortation it would be from 
Shakespere's story of Julius Caesar. u It is not in our stars, dear Bru- 
tus, but in ourselves, that we are underlings." We are not upholding 
our own with the loyalty that our own deserve. As Americans we are 
especially prone to believe that the " Made-in-Germany " placard 
stamps the article as genuine and particularly valuable. We ramble 
over Europe, admire, wonder and adore, forgetting that the wonderland 
of the whole world is contained in our own Yellowstone Park. If it had 
been " Made-in-Germany " it would have submerged our souls in 
ecstasy. And so it is with the glories of our homeopathic school. A 
young man asks, " Where shall I study medicine ?" We discuss home- 
opathy with him, apologetically perhaps, tell him that we are medical 
specialists, that diagnosis, pathology, etc., may be taught better in the 
old school college, and at last it is agreed that to study in the regular 
school first, then "pick up" homeopathy last, is a good plan. A 
glamour, due to their large chemical, bacteriological, and pathological 
laboratories, is before our eyes. We think we see the " Made-in Ger- 
many " sign. We forget that our law of similars was literally made in 
Germany, and that there is nothing in those laboratories that can com- 
pensate our student for the years spent in the study of our materia 
medica. Besides, we have excellent laboratories of our own. Enough 
is taught to make our student broadly intelligent and practically skill- 
ful. What more does he want? Above all, does he want more labora- 
tory and no homeopathy ? Remember, too, that it is very improbable, 
after sitting under the tuition of the regular school for four years, that 
he will desire homeopathy. On the contrary, he is likely to make you 
desire a diploma like his, which will muddle you still more, unless you 
are of the rare mental type which discerns the helplessness of the allo- 
pathic therapeutist. To know and to appreciate our own colleges to 



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332 THE CLINIQUE. 

the point of an abiding loyalty is but another form of reciprocity, 
brought home and made practical. The same may be urged regarding 
our specialists and consultants. We gain nothing by tentatively ad- 
mitting that the men of our school are second to any. It does not 
show breadth so much as it shows lack of acumen. We can get no 
better advice and help from those not in sympathy with us and our 
methods than we can get from our own. The old school, as well as an 
intelligent public, have a healthy respect for the loyal, consistent 
homeopath who sincerely believes in and respects himself and his 
school. 



SOME OF THE THINGS THAT I TIE TO AND WHY. 

S. H. AURAND, M. D., CHICAGO. 

Doctors are usually anxious and willing to tie to patients if they can 
only get the patient to tie to. My good families that I have thoroughly 
learned and have confidence in, and who have learned me and have 
confidence in me, I like to tie to, because I feel that I am of service to 
them and they are of service to me. To do our patients the most good 
it is just as important that the doctor has confidence in his patient as it 
is that the patient has confidence in his doctor. Harmony should pre- 
vail, and the best results are obtained when there is a mutual desire to 
treat and be treated. In my opinion it is not wise for a doctor to try to 
hold a patient who can have no confidence in him and in whom he has 
no confidence. A patient should not only believe in his doctor, but he 
should believe in his doctor's medicines and methods in order that he 
may faithfully follow him along the winding paths which lead to recov- 
ery. The doctor's interest in his patient has much to do with the pa- 
tient's interest in his doctor. The doctor's reward depends, not so 
much upon the number of patients he treats, as upon the number of 
patients he cures, not so much upon the number of calls he makes as 
upon the amount of good he accomplishes, not so much upon the num- 
ber of dollars he receives as upon the relief and benefit he gives. Up- 
on the homeopathic principle in order to have your patients tie them- 
selves to you you must tie yourself to your patients. Upon this home- 
opathic principle and the application of good homeopathic remedies I 
believe depended the life of the following described patient. 

In the month of May, 1905, a single lady of about thirty-five years, 
who had never seen me before, called at my office, on the recommend- 



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THE CUNIQUE. 333 

ation of a friend, for examination and treatment. The stress of her 
complaint was based on a failure to menstruate. She said that she had 
not menstruated for nearly three months and before that had always 
been regular. Her limbs were full and edematous up to the knees and 
she was very nervous, pale and anemic. She complained of frequent, 
scanty urination with more or less irritation and smarting. Her ap- 
petite was poor and she looked as if she hadn't good blood enough to 
stimulate the menstrual function. She said that she had had several 
very nervous spells, so nervous that she could hardly sit, stand or lie 
down. Her muscles would twitch and jerk and she said she felt very 
peculiar. She had puffiness about the eyes and she complained of 
burning, stinging senations in the skin. Her pulse was rapid and 
weak and she looked and acted frightened. The urine was heavily 
loaded with albumin and the specific gravity was 1010. She had little 
or no thirst and therefore drank practically no water at all. Tea and 
coffee constituted her drink for a number of years. In fact she said 
nearly all her life she drank but little else. It is needless to add that 
tea and coffee were absolutely forbidden and that she was instructed to 
drink plenty of good pure water instead. Milk and water constituted 
her entire diet for the first few weeks of treatment. Then for several 
months she lived practically on br^ad and milk. She followed direc- 
tions implicitly and called at the office regularly, each time with a 
sample of the urine, for medicine and instructions. I prescribed apis 
mel. 3x and arsenicum alb. 3x to be taken alternately each hour. I 
realize that the alternation of remedies is open to criticism, but I am 
not fixing up a paper simply to sound well, I am giving you my actual 
experience and practice. I gave apis mel. because the skin had a 
whittish, waxen and transparent appearance, the urine was scanty, ir- 
ritating and highly albuminous, the eyes were puffed and the limbs 
edematous, there was burning and stinging sensations in the skin, there 
was amenorrhea and no thirst. I gave arsenicum because of the white 
skin, the burning sensations, the pale lips and mucous membranes, the 
puffiness of the eyes, the edema of the limbs, the weak, irritable circul- 
ation, the general anemic condition and prostration, loss of appetite 
and disordered digestion, general nervous condition pointing to convul- 
sions, scanty, smarty and albuminous urine, great restlessness, anxiety 
and fear, and because she said that warm things were very pleasant to 
her. 

My patient made marked and uninterrupted improvement from the 
very beginning of the treatment. Each examination of the urine 
showed less albumin and better specific gravity. This patient came to 



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334 ' THE CLINIQUE. 

the office twice a week regularly for about three months and then once 
a week for about nine months. Long before the year was up there was 
absolutely no trace of albumin in the urine. The menstruation became 
regular, appetite normal, she gained in weight, she looked well and 
was well. Apis mel. and arsenicum alb. were the only medicines used 
and they were given less frequently as the case progressed. 

I like to tie to such patients because of their fidelity and loyalty. 
They give the doctor a chance to cure them. And I like to tie to such 
remedies because they cure the faithful patients. Apis mel. and arsen- 
icum alb. are my stand-bys in such cases as I have just described. I 
tie to them because they have so many times served me well. I some- 
times employ one alone and sometimes both, as in the above case. 

Spigelia is a remedy in which I have much confidence in neuralgic 
headaches. The pain usually begins in one spot and radiates in differ- 
ent directions. It may begin in one eye or it may radiate to one eye 
usually the left. The eye is weak, watery and sometimes looks red and 
inflamed. This condition may extend to the nostril of that side. 
Sometimes the pains extend down into the muscles of the neck and 
even down into the left chest. They may be very excruciating or 
simply severe enough to make one nervous, irritable and all out of 
sorts. The pains usually begin in the morning and continue with in- 
creasing violence until along toward evening when they begin to sub- 
side. You needn't hunt for a great mass of symptoms when spigelia is 
the remedy because as a rule the patient can think of nothing but the 
pain and discomfort. A christian science patient who had suffered all 
day under the treatment of a healer could endure the excruciating pain 
no longer and so telephoned to me to come in haste. She pointed to 
the exact spot in the side of the head where the pain begun and said it 
extended up over the head to the eye and down into the muscles of the 
neck. The eye was red and watery and she felt as if she could not 
move her head without suffering severe and excruciating pain. Spige- 
lia, in harmony with its law and affinity, quickly demonstrated its 
ability to relieve, and thereby sustained its great reputation. It did 
more, it made a convert to homeopathy, for this patient has ever since 
been a staunch believer in homeopathic * medicine. Carry spigelia 3x 
in your medicine case and prescribe it in these cases and you will get 
results. 

Hyoscyamus. — There are two conditions in which I have learned to 
respect hyoscyamus. One is enuresis in children and the other is 
nervous delirium in fevers. I have cured many cases of enuresis in 
children with this remedy and it is the first remedy I think of when 



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THE CLINIQUE. 335 

these patients are presented. They cannot retain their urine, as soon 
as they think of urinating, or as soon as the sensation is felt they must 
go immediately, and they must hustle or the urine will get the start of 
them. Indeed in some of these cases they do not think of it until after 
the mischief is done — the urine passes involuntaiily. The bed and 
clothing of these children is constantly wet and highly odorous. These 
little patients usually show signs of more or less constitutional nervous- 
ness. They are liable to act spasmodically. They are fidgety, have 
restless nights with more or less jerking and muscular twitching. If 
you have not tried hyoscyamus in these cases try it and you will not be 
disappointed. I use it in the second and third potencies. 

My second use of hyoscyamus is in acute mania or nervous delirium 
in fevers. I have found it useful when the patient is in a very 
restless, trembling and nervous state. He is very suspicious of his sur- 
roundings. He is very busy, constantly working and fussing with 
things about him — constantly picking at the bedclothes and is in great 
trouble with this or that. He is constantly trying to remove the bed- 
clothing or his wearing apparel — I think not so much to expose him- 
self as because he is in great trouble. In his muttering delirium he 
has much complaint. Not long since I had a case of typhoid fever who 
was in a very weak, nervous and delirious state. His whole body 
trembled and he was constantly working and picking at the bedclothes. 
In his muttering delirium he tried to express his troubles and com- 
plaints. The urine and feces were passed involuntarily. The 
nurse and two other ladies were constantly employed in keeping him 
in bed and adjusting the clothing. He was not quiet and did not sleep 
five minutes at a time for two nights and one day. After taking the 
second dose of hyoscyamus 3x he ceased his muttering complaint, his 
trembling stopped, his muscles relaxed and he fell off into a quiet sleep. 
In three hours he waked up perfectly rational and in a quiet, peaceful 
frame of mind. This marked the beginning of his recovery which took 
place without further delirium or nervous disturbance. 

I use hyoscyamus in these cases in from the second to the sixth po- 
tency. In the above mentioned conditions its indications are clean 
cut and its results are sure. 

Cimicifuga. — There are several therapeutic conditions with which I 
am quite willing to fully trust cimicifuga. Cimicifuga has a definite 
place in my armamentarium and when called upon it does not disap- 
point me. It is not a cure-all for rheumatism and dysmenorrhea, but 
it will do all that it agrees to do if its law is understood and if it is 
treated fairly. Its subject is usually nervous and irritable, talks at ran- 



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336 THE CLINIQUE. 

dom and changes subjects frequently. The soreness, aches and pains 
are usully in the body of the muscle. If with the above tendencies 
your* patient has lumbago, crick in the back or neuralgia of the lumbar 
muscles so that he can hardly get up when down or down when up, the 
least effort to move catches him with such excruciating pain that he 
gives vent to his feelings with a characteristic grunt or groan, and if he 
tells you that he is subject to these attacks, which usually lay him 
up for from one to three weeks, give him cimicifuga and watch him 
crawl out. The dose should be five drops of the tincture every two or 
three hours. The results will prove to you and to the patient that 
cimicifuga is at home with such cases and right after the business where- 
unto it is sent. 

Then again cimicifuga will serve you just as well as if prescribed for 
a nervous, hysterical patient, who is irritable and complains of a good 
deal of jerking, trembling or twitching of the muscles. She is rheu- 
matically inclined and her menstruation is irregular, delayed or sup- 
pressed. She complains very much of aches and pains in the region of 
the uterus and ovaries. These pains extend upward toward the back 
with more or less involvement of the lumbar muscles. Here cimicifuga, 
in the second or third potency, will increase the doctor's faith in med- 
icine and will make the patient comfortable and happy. 

Veratrum Album. — There are three therapeutic conditions for which 
experience has taught me to tie to veratrum album. First, a peculiar type 
of mental and nervous difficulties; second, digestive troubles; and third, 
menstrual disorders. If you have a cranky patient who has a violent, de- 
structive disposition, whose emotions prompt him to spasmodically tear 
things to pieces and destroy them, and whose religious frenzy impels 
him to exhort and pray with vehement fury — so much so that he turns 
pale and cold and cold sweat stands out on his forehead — and at other 
times when he is tired and exhausted he is dull, stupid and fearful; 
whether this be a state of delirium in the course of a running fever or 
whether it be due to a nervous state of unbalanced mentality: — give 
him veratrum album 3x and the above symptoms will change or van- 
ish. 

Second, if you have a patient who is taken with violent nausea, ret- 
ching and vomiting, and his blood seems like ice water coursing through 
the vessels, with cold, clammy sweat, especially on the forehead, who 
craves ice cold water, juicy or salty things, who suffers with severe 
abdominal cramps, the intestines feeling as if they were tied in a knot, 
and who has copious liquid or rice water stools, give him veratrum al- 
bum 3x, which is powerful enough to overcome all the combined vio- 
lence above mentioned. 



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THE C UNIQUE. 337 

Third, should you have a patieut who at times descends into the 
lowest depths of despair and with a sudden bound she throws her arms 
about your neck in a spasmodic effort to kiss you, you will remember 
that the patient is only ill and wants, not you, but veratrum alb. This 
patient just before her menstrual period comes on is very blue and in a 
state of utter despair, she may be very hysterical or even violently in- 
sane. When the menses begin to make their appearance she passes 
into a frigid zone. She has violent uterine cramps with rigidity of the 
body and icy coldness, especially over the abdomen. She suffers ex- 
cruciatingly, has cold, clammy sweat and is greatly prostrated. Verat- 
rum alb. will not only relieve but it will absolutely cure these cases. 
Remember that veratrum alb. is a valiant remedy in violent cases. 

Podophyllum. — Podophyllum has a special place in my medicine 
case and I am often reminded of its usefulness. I occasionally pre- 
scribe podophyllum in one-fourth grain dose. This serves me very 
well as an intercurrent remedy in torpid conditions of the liver and 
digestive organs. The patient has no appetite, the tongue is heavily 
coated and the mouth foul. The bowels are constipated and there is 
an aching fullness in the stomach, liver, abdomen and rectum. These 
patients usually suffer more or less with bleeding hemorrhoids. They 
also have a heavy, dull and confused headache with no ambition for 
mental or physical labor. 

Now should I find the above condition in a patient who on account 
of the sluggishness of the digestion continues to load up for a while and 
then with a desperate and stormy effort the system reverses the order of 
things by producing a copious diarrhea, I should prescribe podophyllum 
in the third decimal potency. 

The podophyllum, patient usually suffers with gastric, bilious or 
duodenal catarrh and the following symptoms are noted: — Full, heavy 
and confused headache, no appetite, thick, foul and pasty coating on 
the tongue,more or less nausea or nausea and vomiting, full, sore feeling 
about the stomach, liver and abdomen, dirty or brownish color of the skin 
and more or less melancholy with mental and physical inactivity. 
These patients may suffer with constipation or diarrhea, or constipa- 
tion may continue for a time and then with a stormy rumbling and 
gurgling in the stomach and bowels, a copious, foul diarrhea will fol- 
low. The stools are usually very copious and very foul and are often 
mixed with a mealy sediment. The above short description from a 
bilious patient is sufficient for me to decide upon podophyllum 3x. 

I am sure the above remedies are valuable in other conditions but 
these are practical tests to which I have put them and therefore can 



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338 THE CLINIQUE. 

with confidence recommend them to you for similar cases. There are 
many other good homeopathic remedies to which I tie, and use for var- 
ious difficulties, but I cannot tell you about them in this* paper — else 
it would be too long. 



GASTROPEXY. 

M. B. BLOUKE, M. D., CHICAGO. 

Securing to some fixed point of support a displaced stomach, is 
known as gastropexy. 

Descent or ptosis of the abdominal organs is known by various names 
as splanchnoptosis, visceroptosis, Glenard's disease, etc. Descent of 
special organs, as ptosis of these organs viz: — Gastroptosis, Nephro- 
ptosis, Coloptosis, etc. The descent or prolapse of the abdominal organs 
is a much more common condition than many of us have hitherto 
believed, and is a factor to be carefully considered in making diagnosis 
of abdominal and pelvic lesions. 

Apparently the most common points in the abdomen where a viscer- 
optosis produces symptQms are the points of greatest surgical interest 
viz : — the appendicular, the pelvic and the gall bladder regions. In 
the right inguinal region we find the appendix such a frequent offender 
that when we find it sensitive or painful we remove it before it becomes 
gangrenous or perforated, and becomes a special menace to life. I 
admit that in the past I have removed appendices that apparently 
seemed normal, yet the subjective symptoms were pronounced. It 
must be borne in mind that an appendix apparently normal, when 
examined microscopically may show pathologic changes. It has been 
my observation that a number of these cases where no apparent lesion 
of the appendix is found the appendices contain soft fecal matter and 
that the patients are the victims of enteroptosis. In several such cases 
I have been able to follow the whole course of the colon to and includ- 
ing the sigmoid through a small muscle splitting incision. 

The first case in which I observed this condition, the diagnosis of 
appendicitis had been made and operation advised by admittedly the 
best old school authority on this subject in the city, as well as by two 
of our best medical men, one of the old school. The operation did not 
give a symptomatic cure. 

After several similar observations my colleague, Dr. W. F. Becker, 
began taking radiographs with the idea of locating accurately the colon 
and the stomach in these cases. 



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THE CLINIQUE. 339 

The findings were interesting. While I was familiar with Glenard's 
disease and frequently inflated the stomach with gas to outline it more 
accurately, I was not aware of the extreme descent of the colon until 
demonstrated by Dr. Becker. 

A few days ago Dr. Becker called my attention to a radiograph, 
which I present for your examination, in which the transverse colon 
drops in a festoon as low as, or even into the true pelvis. The sub- 
ject, a medical student in one of our allopathic colleges, had undergone 
an operation for appendectomy. The surgeon informed him that he 
had difficulty in finding the appendix because he had a redundancy of 
colon and that he would advise extirpation of 15 to 18 inches of it in 
order to give him complete relief of his symptoms. 

Since our investigations along this line there have appeared several 
interesting articles in medical journals, and also, the last edition on 
" Diseases of the Stomach " by Einhorn, in which radiographs appear 
similar to ours, taken at least a year before these publications appeared. 
I mention this because radiographs are misleading at times, as we all 
know, unless the utmost skill and care is exercised in making them. 
It was therefore an agreeable surprise to us that such an able and care- 
ful diagnostician as Einhorn should practically verify our radiographs. 

I do not wish to consume the time of this society in writing at length 
on the causes or symptoms of enteroptosis because they are given in a 
number of text books. Suffice to say that these patients are usually 
neurasthenics, spare in build, with flaccid abdominal walls and com- 
modious abdominal cavities. When the patient stands the lower abdo- 
men seems full and rounded, while the epigastrium seems caved in. 

In the year 1900 Einborn examined all his private patients with regard 
to visceral ptosis. The total number was 1912 — 1080 males; 832 females. 
Among these were found 347 cases with ptosis of the abdominal viscera 
— 70 men; 277 women. Among these were 240 cases of enteroptosis — 
20 men and 220 in women. In most of the cases the enteroptosis was 
accompanied by a movable kidney; 212 — 18 in men and 194 in women. 
Among the cases of enteroptosis with movable kidney, 23 also had de- 
scent of liver — 3 men; 20 women. Enteroptosis with floating liver, 
unaccompanied by movable kidney was noted in 12 cases — 1 in a man 
and 11 in women. Enteroptosis alone (the kidneys and the liver being 
in their normal places, the only symptoms being a descent of the stom- 
ach and a strong pulsation of the abdominal aorta) was found in 15 
cases — 1 male and 14 females. Movable kidney alone 57 times; males, 
21; females, 36. 

Glenard found enteroptosis in 400 out of 1300 cases examined; 
Ewald in 13 % of his cases. 



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340 THE CLINIQUE. 

A few years ago a surgeon in the feast called the attention of the pro- 
fession to the frequent association of nephroptosis and appendicitis. 
His observations no doubt were correct, but it is a question whether he 
was not dealing with an enteroptosis as an associated condition. The 
frequent appendicular involvement in these cases must be due to the 
sluggishness of the colon. The fecal current is impeded and this in 
time causes a catarrhal inflammation of the colon and by continuity ex- 
tends to the appendix. 

Our cases operated on during the last six months have been benefited 
much more than by any treatment given them prior to the operation. 
So far I have had no unpleasant results. I have been careful in select- 
ing my cases. I have not operated on cases with ptosis of any other 
of the abdominal organs than the stomach and intestines. There is no 
reason why nephroptosis, hepatoptosis and ptosis of the stomach and the 
intestines cannot be operated on at the same time, the patient being in 
reasonably good condition. I report two cases, one operated on October 
8th, the other November 20th of last year. Seven and six months respec- 
tively since operation, a time long enough I think to form some reason- 
ably fair conclusion as to results. . 

The treatment for visceral prolapse has been almost exclusively med- 
ical. Vide: — Einhorn, Hemmeter, Nothnagel, Osier, Trucke, Black- 
wood. Some of the above authors say: " surgery cannot possibly give 
any relief" yet they admit that in some cases their methods of treat- 
ment avail nothing. One author says: " when surgery is undertaken, 
it should be complete in every detail." " The liver and kidney should 
be sutured, the gastro-hepatic omentum shortened, the transverse colon 
fixed, and the . abdominal wall reconstructed." This outline for the 
surgeon is rather broad gauge. 

After reading carefully all the literature at my command on visceral 
prolapse, I concluded that the specialists in this class of disease differed 
so much as to treatment and results, and that it was neither safe nor 
right to turn all these cases over to them. 

Last October a gentleman 40 years old, spare build, with the history 
of gastroptosis, and inability to get any relief from the internist, pre- 
sented himself for operation. The radiograph I show you (made by 
Dr. Becker) confirmed the diagnosis. No ptosis of kidneys or liver. 
Theoretically at least, shortening the gastrohepatic omentum seems the 
ideal operation for this condition, and it was this method as suggested 
by Beyea that I intended to follow. An incision 3 inches long was 
made a little to left of median line and between ensiform cartilage and 
umbilicus. The stomach was drawn up and out of the incision and a 



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THE CLINIQUE. 341 

careful inspection of the lesser omentum showed it to be so thin that 
touching it would seem to tear it. A condition similar to that found 
by Dr. Eve of the London Hospital in his four cases operated on. It 
was evident that no kind of stitching could be borne by this delicate 
membrane. The stomach was anchored to the anterior abdominal wall 
by continuous suture, the stitches in the stomach being placed as near 
the attachment of the lesser omentum as possible. When completed a 
row of sutures 2}4 inches long extended transversely across the 
abdomen, the abdominal incision was closed, a pad over lower abdomen 
with considerable compression applied and patient put to bed. In 
about four weeks this patient left the hospital feeling well. He was ad- 
vised not to return to work for about two or three months. By this 
time he had gained 20 pounds and since has attended to his duties and 
feels much better than formerly. 

Duret first suggested and practiced gastropexy, and reported the 
same in 1896. 

Theoretically, attaching the stomach to abdominal wall is wrong, 
but practically apparently not. Some operators claim that not infre- 
quently are they called upon to break up adhesions between the stomach 
and the anterior parietes, because of the pain they cause. It must be 
remembered, however, that these adhesions as a rule are due to and 
follow some form of inflammation such as cholangitis or gastric ulcer, 
and the adhesions resulting therefrom may interfere proportionately 
much more with the mobility of the stomach because of a wider attach- 
ment, or a vicious attachment causing stenosis by a possible rotation of 
the stomach. The attachment to the parietes of the stomach at or near 
the lesser curvature by proper stitching is more in the nature of a gas- 
tro-suspension than fixation, and I believe a ligament forms serving 
well in the capacity of a lesser omentum and with no material interfer- 
ence with the mobility of the stomach as claimed, but with all the ben- 
efits derived by holding the stomach near its natural moorings. 

Byron Davis in a recent article in Annals of Surgery reports 7 cases 
operated on successfully as to results by attaching the lesser omentum 
to the abdominal wall. When the omentum is strong enough so the 
stomach can be suspended by attaching it to abdominal wall, it would 
seem to me that plicating it as recommended by Beyea would be the 
more desirable procedure. In the cases I have operated on, in not one 
of them was the omentum strong enough so as to use it in anyway as a 
means of support for the stomach. 

The other intra-abdominal operations as Rovsing's and Coffey's offer 
no advantages, but are objectionable. The former positively produces 



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342 THE CLINIQUE. 

an extensive gastro-fixation, and the latter attaches the gastrocolic 
omentum near the greater curvature of the stomach to anterior abdom- 
inal parietes making a swing or hammock for the stomach. It would 
seem that this would favor rotation of the stomach on its long axis and 
possibly cause a stenosis at or near the pylorus. 

Reconstruction of the anterior abdominal wall as suggested by Depage 
is unnecessary. When divigation of the recti muscles is associated with 
ptosis resection of the fascia and approximation of the muscles is cor- 
rect. 

On November 20th last the second operation was performed on a 
lady 50 years old, who had made the rounds of the internists without 
relief. This patient also has made a good recovery, her general health 
being much better than formerly. I report only these two cases be- 
cause they have been operated on about six months ago and I feel the 
time has been long enough to form some conclusion as to the result 
obtained. The cases operated on since promise equally good results. 

In closing I wish to say that all additional measures having a tend- 
ency to improve the retentive powers of the abdomen are beneficial. 
Voluntary, alternate contraction and relaxation of the abdominal mus- 
cles, patient recumbent, is the form of exercise in my judgment most 
beneficial. Massage, hydrotherapy, bandaging and dietetics are other 
measures to be utilized in the treatment of this condition of visceral 
prolapse. 



IMPORTANT REMEDIES NOT WIDELY USED.* 

G. A. LEACH, M. D., MORRIS, ILL. 

When I received Dr. Cowperthwaite's letter asking me to write a 
paper for the Bureau of Materia Medica, it found me with more duties 
to perform than I had time to give to them, but it occurred to me that 
in our strenuous life, in which each year of the 20th century seems to 
exceed the last in its increasing stress, that it might be well to pause a 
few moments and consider if possibly we, as students of materia med- 
ica, are not leaving some of our best remedies to be trampled under 
foot, or at least if they are not receiving the recognition they deserve. 
You know the tendency of the age is to rush after the new things, (we 
homeopaths are not as bad as our old school brethren in this respect, 

*Read at the 52nd Annual Meeting of the Illinois Homeopathic Medical Associa- 
tion, Sherman House, Chicago, 111., May 16, 1907. 



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THE CLINIQUE. 343 

for we still use a large number of our old reliable remedies which we 
can depend upon today as well as in Hahnemann's time). 

In mining we find that the dump piles of old mines are being worked 
over and yield good returns. In agriculture we find the desert, until 
recently considered worthless, blossoming like a rose under the bene- 
fits derived from the Irrigation and Reclamation Act of 1902. Right 
here in Chicago you have been trying for years to burn your own 
smoke. Why should we not stop and consider if we have not been dis- 
carding as of little use remedies that with more study would be a boon 
to suffering humanity ? Hence this subject. 

In calling attention to the various remedies that I shall mention I 
shall not attempt to go into the symptomatology very deeply, but only 
give in a condensed way the more important uses as they have come to 
me in my practice, and to my attention. 

The remedies that to me seem not to be widely used, may be ones 
that you, some of you, are using, but I have selected my list from the 
fact that in my experience with physicians, in my reading from our 
journals, in our Society meetings, etc., I have not heard them men- 
tioned as frequently as others. 

Anthemis Nobilis, or Roman Chamomile. — An herb so old and 
obsolete that there are few drug stores that carry it in stock. Yet a 
decoction of the blossoms, with the addition of sufficient calendula to 
keep from fermenting, applied to suppurating sores, gangrenous ulcers, 
bone lesions, etc. , selecting your cases where there ^are indications of a 
need of silica, (as that seems to be the remedy contained in the flowers) 
will surprise you with the results. A tea made from hay will do 
wonders in such cases. I accomplished more in three days with hay 
tea in a case of fistulous discharge after amputation of a little toe than 
the old school doctor who had performed the amputation had accom- 
plished in nine weeks dressings. Hay tea eventually healed the dis- 
charge. 

We who are practicing in the country can often step outside of the 
house wherein we are called, and if in the proper season, pick or dig 
some plant, or root that will meet the indications in the case at hand. 
I remember several years ago being called to attend a young girl suffer- 
ing from facial neuralgia. She had suffered severely for two days. I 
picked some common plantain leaves, (plantago major), made an in- 
fusion, wrung out hot clothes and applied, relieving the pain in a very 
short time. Plantago is also very useful in diarrheal troubles and in 
the form of a cerate for skin diseases attended with an irritating, burn- 
ing, scalding and itching sensation. Study this plant; it is worth your 
time. 



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344 THE CLINIQUE. 

How often I have used the very common elder flower in treating 
erysipelas; in fact it is my favorite treatment. Just make a tea of the 
flower, wet cloths and apply, cover closely with oil silk; also give of 
the tea liberally as a drink. 

The common peach tree. — Pick the leaves, bruise and cover with 
cold water, give the infusion in teaspoonful doses in cases of vomiting, 
of pregnancy, gastric irritation in children, in some bilious conditions, 
etc. 

The mother tincture is made from the bark of tender twigs, macer- 
ated in 87 % alcohol, used in from 2-5 drop doses in cold water, and de- 
pends on the hydrocyanic acid contained for its action. 

Last summer I made up several pints of tincture of avena sativa, our 
common field oats. Gather when in the milk and macerate in 87 % 
alcohol. I use it in from 5 to 60 drop doses; in the larger doses as a 
sedative nerve tonic, in alcoholism, morphine, or other drug habits; in 
smaller doses as a nerve tonic, it is a very useful remedy. 

Verbena Hastata. — About one dram of mother tincture to 2-4 oz. 
water applied to skin surfaces poisoned by poison ivy will, in a large 
number of cases, relieve and cure; it is also said to be useful in ' %-% 
teaspoonful dose in cases of epilepsy and whooping cough. I have 
never used it in the last named condition. 

'Tis but the last few years that the old school has begun to use cac- 
tus grand. , generally as a heart remedy. We homeopaths are familiar 
with the symptom, "pain in region of heart;" " feels as if an iron 
band were around it," etc. But do we stop to think of the opposite 
effect, i. e. , the physiological action ? That we can with this remedy 
in effect put a band around a weak, relaxed heart? 

Cactus grand., to my mind, is one of our most useful heart remedies, 
I say " heart remedy" because that seems to be the most important 
use found for it to date. We are all more or less familiar with its use 
in potency in cases, with symptoms of constricting pains in region of 
heart, with palpitation as above, and how nicely it meets the indica- 
tion, but I have come to use it more in physiological doses in cases of 
weak or relaxed heart. In extremes where you wish to prolong life by 
keeping up the heart action I depend on cactus grand., after strychnia, 
digitalis, and other powerful heart stimulants have failed. (I use P. 
D. & Co's fluid extract 1 part and dilute alcohol three parts, 3 to 15 
drop doses, as the strength is always the same. ) The most complete 
article I have read on the action of cactus grand, you will find written 
by Dr. W. A. Dewey, in Medical Century, December, 1906. 

Solidago Virga Aurea (Golden Rod). — A very useful remedy in 



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THE CLINIQUE. 345 

conditions of difficult urination, enlarged prostate, incipient albumin- 
uria, etc. It is very healing to the urinary tract in small doses, say 1-5 
drops ix, twice daily; also used in larger doses say 10-30 drops tinct- 
ure diluted as a preventative of hay fever. This remedy needs more 
study. 

Fraxinus Americanus. (American Ash). — Said to be useful in 
hyperplasia of the uterus. I have been unable to find any literature 
more than the above upon this remedy. I have never made any prov- 
ing but have used it in quite a number of cases and from my observation 
clinically have come to the conclusion that the primary action is upon 
the portal circulation. The reduction in size of the uterus coming 
secondarily from the relief of pelvic congestion caused by the sluggish 
portal circulation. We have another of the Ash family, ptelea 
trifoliata, or wafer ash, which is recommended as being indicated in 
liver troubles characterized by aching pain at root of nose, tongue 
brownish yellow, atonic state of stomach, feeling of weight in right 
side; not a pressure like podophyllum, but a heavy weight. Then we 
have xanthoxylum fraxinus, or prickly ash. This species of ash seems 
to act on the cardiac and solar plexus. When taken in tincture say 10 
drop doses, it increases the flow of saliva and other digestive fluids, pro- 
duces a peculiar tingling sensation when touched to the tongue. This 
species of ash has been in more general use than the other. The old 
school use it in chronic rheumatism; also as a stomachic tonic. It enters 
into quite a number of home remedies and will hardly come under the 
title of this paper, although I mention it in connection with the other 
species of ash. 

The balsams of the fir and Peru are worthy of a more extensive use 
than they receive. Balsam of fir is very healing and useful in bronchial 
troubles; also in incipient Bright's disease, catarrhal cystitis, etc. 
Balsam of Peru I have used mostly as a dressing on indolent ulcers, 
conditions requiring a softening, stimulating effect. Just pour some 
on aseptic gauze and pack the wound. Change when dry. Try it, it 
gives good results. 

Bovinine, or fresh juice of beef, also is another good dressing in con- 
ditions where the tissues require food. Generally speaking it would 
not be wise to apply such a dressiugon a surface discharging pus freely, 
but I have used it and had wonderful results. 

In inflammatory conditions, requiring a soothing application, I have 
found carrots grated into a pulp very satisfactory and if your condition 
is one following some septic process, put on charcoal mixed with 
enough powdered slippery elm to keep from drying too quickly, wet 



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346 THE CLINIQUE. 

with glycerine. Charcoal you know is first cousin to carbolic acid and 
is one of our best antiseptics. 

And so we might mention remedy after remedy and keep within the 
bounds of " Important remedies not widely used." My purpose is not 
to weary you with mention of a large number, but to emphasize the 
fact that it might pay us to pause and study some remedies at present 
nearly if not quite discarded by the profession as a whole. 

You may criticise my paper as not being sufficiently homeopathic to 
read before this State Society; if so I accept the criticism and reply that 
these are only suggestions to be worked out in each case if thought 
worthy. We try to cure diseased conditions by restoring that harmony 
in our inner life that our Creator put there. We use plants as reme- 
dies because of the similarity or harmony that exists between their na- 
ture and the condition at hand. If that be true then why pass by our 
common plants that grow in the same surroundings that we live in. 
Other things being equal we would expect them to have more in com- 
mon or in haunony with our common diseases than foreign plants. In 
applying them we as homeopaths will use them according to their 
adaption to the condition to be treated and, if we choose, to give physi- 
ological doses when we want physiological action, I for one do not con- 
sider that I am any the less a homeopath for so doing. There are 
conditions that need more than medicine, but whatever the treatment 
it must if successful restore the harmony that has been lost, and quite 
often this can be done by common simple means. 

I plead for a closer study of the common things of life only too often 
passed by. 



MY REASONS FOR NOT STUDYING THE MATERIA MEDIC A.* 

GEORGE E. DIENST, M. D., NAPERVILLE, ILL. 

I am laboring under a sensation of considerable timidity in present- 
ing this paper to you; for I am most certain that there are some here 
who will not agree with me. It is for them, however, that this is 
written, and if it is objectionable they will have the liberty soon to say 
so. My reasons for not studying the materia medica are obvious for — 

First. When a student at college this subject was relegated to a 
minor place in the curriculum and I was made to feel that it was of 
less than secondary importance. 

♦Read at the Illinois Homeopathic Medical Assn., May 16th, 1907. 



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THE CLINIQUE. 347 

Second. There are so many and such varied preparations for the 
market, by " reliable houses," for the cure of disease that a hard study 
for the indicated remedy seems needlessly burdensome. One needs to 
name but a disease, and you turn to your bottles and there is your pre- 
paration ready without a thought. 

Third. The public and the profession at large care little or nothing 
about the indicated remedy. The public wants tangible medicines — 
things that have color and taste — and the profession in general caters 
to the demand of a " wise and educated public," and why should not I ? 

Fourth. I am not of the studious kind — having peculiar predilec- 
tions for street corners, pool rooms, drug stores, and society's demands 
— nor have I a sufficient amount of gray matter necessary to a careful 
and correct understanding of the totality of symptoms and the indi- 
cated remedy. 

I am very sure that you will agree with me that these reasons are 
both scientific and logical, and are worthy of your most considerate 
attention. To be more practical, however, permit me to illustrate a 
few points, so as to set myself in the proper light, if the above has not 
been sufficiently clear. 

Take the case of a simple coryza. What do I care whether the 
patient sneezes or does not sneeze; whether there is a discharge from 
the nose or not, as to whether that discharge is bland or acrid, whether 
there is a headache, cough, fever, or any other symptoms. I know 
and know it well that when these symptoms are properly obtained and 
the remedies selected accordingly the patient will recover speedily; but, 
it is sufficient for me to know that he has a cold, and that tablet number 
13 or huge doses of quinine is the " scientific" method of curing a 
cold, and that it meets the public demands; if my patient does not re- 
cover I have but to repeat the doses. Why should I call upon a de- 
pleted or scanty reservoir of gray matter to ascertain the particulars in 
this case? and how can an enlightened public, accustomed to " scien- 
tific treatment," appreciate my efforts in this line? I am doing the 
" scientific thing " and more cannot be asked of me. 

Let us go further; here is a case of pneumonia, I have made my ex- 
aminations and sputa tests and there can be no question about my diag- 
nosis. What have I to do? Simply quiet the rapid heart so as to re- 
duce the temperature, — by some sedative, — cold-tar products for in- 
stance — give an expectorant to enable my patient to throw off any ac- 
cumulated mucus, give freely of saline eliminatives to keep the intesti- 
nal tract clear, put on an antiphlogistic jacket to absorb accumulated 
exudates, and what more could you ask? Of course, if the heart grows 



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34« . THE CLINIQUE. 

faint or weary whip it up with some stimulant. If the patient dies — 
well, the public expects this; it has learned that pneumonia most fre- 
quently results in death, but "I have done all that can be done," I 
have met popular demands, my treatment will not be called into ques- 
tion > and — whether death or recovery follows — I merit the eternal grat- 
itude of the immediate family. 

I know, however, that if the case is taken upon its own individual- 
ity, the symptoms carefully mastered and the indicated remedy in the 
proper potency administered, the patient has a hundred chances to one 
of recovery and cure, but ''science" has decreed otherwise, and I, above 
all, "am scrupulously scientific " and must follow "scientific lines." 
Moreover, I have not the quantity, nor the quality, of gray matter to 
waste time on the indicated remedy. 

Take, again, the common terror of mankind. — diphtheria. Here, 
also, I know, and know it well, that the properly selected remedy will 
cure in the vast majority of cases. But why should I try with all the 
strength of soul and body to ascertain whether the disease starts on one 
side or the other, whether the membrane extends to the throat or nose? 
I see a patch on the tonsil, find a rapid pulse and a rising temperature, 
and my diagnosis is established, "confirmed by the presence of the 
causative bacillus." 

" Science has decreed that this case needs antitoxin," the public is 
encouraged to demand it, the family and neighbors who have seen it 
tried, more often than the physician, call for and urge its use, and all 
I need to do is to administer the remedy. If 3000 units will not suffice, 
I will give more and repeat until I get results, if the patient lives. 
Heart failure — paralysis ? What do I care for that, " am I not strictly 
scientific?" My work is to cure this case of diphtheria; I am not to 
worry about results unfavorable. If there is a sequel, then I will look 
after that when time and circumstances demand. 

Do you not see that my scientific measures are infinitely easier than 
the dreary study of the materia medica? And, yet, I repeat, I know 
the indicated remedy will do the work and do it well, but how am I to 
find it? 

Shall I take my repertory and study the major symptoms and the 
remedies therein indicated, and then compare the leading remedies to 
ascertain which one Covers the totality of symptoms ? Yes, I know 
this is helpful, and will not only aid me in the selection of the proper 
or indicated remedy, but will also aid me in understanding my patient 
and his ills, but I am "altogether too scientific" for such laborious 
tasks. 



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THE CLINIQUE. 349 

Suppose I am called to see a man suffering from an, acute attack of 
entero-colitis, his knees are drawn up to his abdomen to relieve his 
sufferings, the muscles of the abdomen are hard and tensely drawn, and 
he wants relief. I know that the indicated remedy will relieve him 
and do it quickly and may possibly prevent future attacks, but he wants 
a tangible demonstration of the healing art, and I know that if I do not 
perform it my " scientific " colleague will, and quicker than he can say 
so, I whip out my hypodermic needle and give him a " hypo " of 
morphine. He has pain, it is not absolutely necessary for me to ask 
where nor what kind, hypodermics are the things for pain, and I give 
it. If one treatment does not cure, I will give the second and repeat as 
often as necessary. Gentlemen, I have seen my scientific colleague 
operate in this manner for three days on one case of simple colic, and 
he received the everlasting praises of his patient and the patient's 
friends. Why ? The man does not hesitate to boast of the severity of 
the attack and the number of hypos it took to relieve him. Is this not 
sufficient reason for me to do the same ? It is popular, made so by our 
" scientific " friends, and I mean to stand by them in these scientific 
exploits along therapeutic lines. 

It seems incredible, though true, that u the laity is growing more and 
mere scientific." Here is just one more point out of hundreds that 
might be named in defense of my position, I refer to obstetrics. You 
find the woman in labor. Her pains are severe. There is a good deal 
of nervousness, the grandmother and old maid aunty are present, and 
something must be done. You find everything normal, but labor is 
rather slow. I know that a remedy suited to the patient and conditions 
will soon bring the new voter or dressmaker into the world, but who 
wants to wait ? " That is not scientific," nor is there any present who 
can appreciate the virtue of a little time, patience and the indicated 
remedy. Why stop to demonstrate what nature, may, can and will do 
with but slight assistance, not one about you at such a time can appre- 
ciate such work. Then what shall I do? u Chloroform the patient, 
and deliver with instruments." This has two decided advantages over 
waiting and the indicated remedy — it popularizes me in the neighbor- 
hood, for an instrumental delivery will be talked of far and wide, — sec- 
ondly — it justifies a larger fee and I need the money. 

Gentlemen, I am more than convinced that you clearly see the logic 
of my points and understand my position with regard to a study or no 
study of materia medica. I am open to conviction if I have left un- 
done the things I should have done, but my points are so strong that I 
indulge the hope that there is no one here able to safely refute any rea- 
son given for not studying the materia medica. 



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THE CLINIQUE. 



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JUNE, 1907. 



The editor of The Clinique is not responsible for any opinion expressed by a con- 
tributor. Contributions are respectfully solicited, ana will be published whenever 
available, providing they are free from personalities, and are not otherwise objection- 
able. Articles for publication, books for review, exchanges, etc., should be sent to the 
editor, 70 State St., Chicago. All business communications should be directed to the 
business manager, Wm. Byford Taylor, 141 Kinzie St., Chicago. 



lAitoxmt 



The State Meetings. — We have taken special pains to compare the 
meetings of homeopathic state societies this year with those of the pre- 
ceding year; we are glad to say that this comparison is entirely in our 
favor. For the most part our meetings have been not alone larger but 
far more enthusiastic; the trend has been positively towards the 
strengthening of our organization and in doing this we certainly have 
overcome the fear of disintegration or assimilation. There never was 
a greater need of homeopathic organization than today and the earnest 
attention given our state associations is a positive proof that our school 
is determined to preserve its identity. No one should question this de- 
termination, for have we not been forced to this splendid isolation? 
There certainly is no excuse for a community of physicians, who have 
been constantly persecuted, who have had to fight for their very exist- 
ence, to give up all that they have worked for. 

We certainly must keep abreast of the times, we must not fly into 
the face of science, we must be modern in our practice, we must not 
confuse the real principle of homeopathy with untenable statements and 
false claims, but we must hold together yet awhile for the sake of our 
identity and our existence. Therefore we must strengthen and main- 
tain our organization. We cannot forget and we cannot recant. 

This journal has stood for the modern interpretation of medicine, for 
the highest ideal in practice and for the acceptance of everything that 
is scientifically correct and practical in therapeutics; but we do not 



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THE CLINIQUE. 351 

propose to see the principle of homeopathy overlooked, and that is why 
we feel that our societies are still needed. 

A doctor of our faith has no right to exempt himself from our mem- 
bership; he has no excuse for saying, " I don't belong to the State 
Society;" he should not claim the right of independence; every physi- 
cian owes his allegiance somewhere; in other words he is with us or 
against us and he should contribute his influence and support where it 
belongs. We cannot be grumblers and help along any good cause; we 
must put our shoulders to the wheel and see that things progress; 
while men may differ as to means and measures the harmonizing of 
ideas may always be attained so that a principle does not suffer. To 
that end we all owe a duty to some organization. 

There are some practicians who have never given this duty a thought; 
they have left college and, becoming engrossed in practice, have failed 
to become associated with their state society; and yet these same phy- 
sicians, when in need of help, are prone to seek the political aid of such 
an institution. If we had no such influence what standing would we 
have in our time of need ? And if the majority of our practicians had 
not maintained our organization what influence would we, as a school, 
have had as a disorganized whole? Therefore* every member of the 
homeopathic profession must wake up and do his duty and continue to 
do it. We should all keep in mind what our predecessors have done for 
us, what they suffered and what they accomplished with the odds 
against them. Where would we stand today if they had not fought for 
our existence as a school ? Homeopathy needs you, Doctor, and you 
need your organization. We trust that our next year enrollment will 
be even larger than it was this year. h. v. h. 



Perverted News. — It has long been a question difficult of solution 
why the daily press depends upon a faulty and sensational news item in 
preference to the unadulterated truth. Why it is that a headline which 
has the evidence of a lie on its face is used to sell a paper we cannot 
yet understand; we all have been brought up on the theory that hon- 
esty is the best policy and we have every reason to feel that this princi- 
ple alone will pay; business men proceed on this principle and, aside 
from the idea of right, it has been accepted as the only successful guide 
to a business career. Why the newspaper of today depends upon the 
crude theory that it is best to fool the people by untenable statements 
and questionable sensation it is difficult to explain. It seems as if a 



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352 THE CLINIQUE. 

two-penny liner was sent out to cultivate a sensation even though he 
misuse the truth; thus a controversy or an extravagant statement is re- 
lie;d upon to attract attention without reference to the controversy. A 
newspaper which ought to be the upholder and the promulgator of 
social excellence in reality becomes the scavenger and newsmonger of 
the neighborhood. Instead of being an accretion to our literature it 
may stoop so low as to deal out yellow news no matter whether it in- 
jures the just or the unjust. This is indeed too bad and we hope the 
time will come when our great American news agency will have a high- 
er ideal and a higher conscience. 

In our recent State Society it seems as if the only news which 
reached the daily press was that of a critical character; isolated sen- 
tences were taken from several papers and extravagant and uncalled 
for interpretations were given which really changed the meaning of the 
context. Worse than all this emasculation of the subject matter was 
used to m.*ke fun of the author, to say nothing of the misinterpreta- 
tions of his true meaning. It is impossible for one to write a paper 
without some side remarks which, if given undue prominence, will 
give a meaning which is truly foreign to his intention. For a news- 
paper to seize upon this and write a "funny" or sarcastic review is 
adding insult to injustice. As we have said before the freedom of the 
press should not be given this extreme license. 

A close inquiry does not show that anyone in authority in our soci- 
ety gave out any news and no one remembers seeing a reporter in 
attendance. Who then gave out this news and who studiously insulted 
our membership by reporting such nonsense ? For several years our 
essayists have been subjected to unjust and uncalled for treatment of 
this kind. We do not see any such unkind criticisms when the old 
school have their meetings and we wonder why we get such treatment 
and who is at the bottom of it all. h. v. h. 



Brainstorms. — The term " Brain Storm," used by an expert 
witness in a descriptive sense at a recent sensational murder trial in 
New York, has become, for the time being at least, a familiar expres- 
sion to all newspaper readers. The yellow press has adopted the ex- 
pression as its own, comic writers and cartoonists have hung jokes upon 
it, clergymen have indulged in " brain storms " over it, and now the 
time has possibly arrived when the medical profession should at least 
dissect this addition to our vocabulary in a sane manner, and endeavor 



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THE CLINIQUE. 353 

to determine whether we pan make a practical and Safe use of the term, 
and what we are going to do about it. 

We now recognize that certain crimes are committed under the in- 
fluence of impulse so strong as to be irresistible. We take this ground 
that if a man has been erratic in his early life, that is, if he has per- 
formed serious acts out of proportion to his personality, he is lacking 
more or less in responsibility. Add to this an hereditary history of in- 
stability in the family tree, and you will be likely to find responsibility 
and stability seriously impaired, and, in the opinion of many, a u brain 
storm " might be expected. 

This doctrine has, to a certain extent, been added to our criminal law 
by the medical profession. The present trend* of medical opinion, and 
its growing effect on the criminal practice in our courts should be most 
carefully safeguarded. Unless this is done many of those who are a 
little irrational, and who are conscious of the fact that these irrational 
acts and their tainted heredity may prove sufficient to keep them from 
punishment, will be tempted to the commission of serious crimes. 

Unfortunately there are a number of people at large, who cannot be 
restrained by their friends, or locked up in an asylum. The fear of 
having to pay the law's penalty is the only protection society has from 
them. This fact will have to be taken into consideration, or we shall 
have a more or less widespread epidemic of crime because of lack of 
proper punishment. A " brain storm "ought not to prevent a convic- 
tion for murder. In England the verdict, where insanity is a mitigat- 
ing circumstance, reads — " guilty, but insane" — and a commitment to 
an asylum follows. 

The delays of justice and the many loopholes in our criminal proced- 
ure, without doubt, are largely responsible for the many no better than 
farce-like criminal trials we have in this country. The last and great- 
est . of these was clearly classified by the prosecuting attorney in his 
closing address, as a deliberate, brutal, tenderloin murder that would 
not have received more than passing notice if the principals had been 
other than a man of genius and a millionaire. 

The defense of the millionaire-for killing the man of genius was a 
" brain storm." Temporary insanity, emotional insanity, querulous 
insanity, transitory insanity, and some others may be considered as syn- 
onymous. Extreme anger and accompanying loss of self-control would 
belong to the " brain storm" class also. That we do have constitu- 
tional, affective insanity, which is essentially emotional and presents 
only formal disturbance of thought, must be admitted. To this type 
we could give the name " brain storm," and so long as the new term is 
thus used, we would be reasonably consistent and fairly scientific. 



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354 THE CL1NIQUE. 

Admitting that the term can be practically applied and fairly well de- 
fended, we now have to consider the legal value of a " brain storm " as 
a defense for crime. At present most murder trials require expert tes- 
timony, and few murder trials of note occur without some reference to 
insanity. If we continue to loosen the claims of justice on all those 
who commit crime on impulse, we shall lose all those deterring influ- 
ences of just punishment, which are even greater over those of lowered 
mentality than over normal individuals. 

As a matter of fact, under the circumstances that surround many ser- 
ious crimes, responsibility is more or less impaired at the moment of 
commission. Many criminologists consider that the . deterring influ- 
ence of capital punishment is the chief reason for retaining it. The 
only method that will tend to keep would-be criminals from trying to 
take advantage of the present trend of public opinion is to maintain 
the majesty of the law by a fitting punishment and with the black mark 
of a murder verdict to properly characterize the crime. 

[The above was presented to the Missouri Homeopathic State Society 
by Dr. G. F. Adams of the Pennoyer Sanitarium, Kenosha, Wis. We 
believe it needs more than a passing notice and have taken the liberty 
to place it among the editorials. — Editor.] 



j^orijetxes* 



THE ILLINOIS STATE HOMEOPATHIC ASSOCIATION. 

TUBERCULOSIS TENT COLONY REPORT — J. P. COBB, M. D., CHAIRMAN. 

To the Officers and Members of the Illinois Homeopathic Medical 

Association: 

Gentlemen — The Tubercular Tent Colony Committee appointed at 
the last regular meeting of the Association desires to present following 
report: 

At the call of the chairman the committee held its first meeting June 
23rd, when there were present Drs. Cobb, Blackwood, Hood, Downs 
and Smith. At this time the work of the committee of the previous 
year was thoroughly discussed and the instructions of the association 
at the time of the appointment of this committee were considered at 
length. In accordance with the power conferred upon the committee 



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THE CLINIQUE. 355 

at the time of their appointment the following members were added to 
the committee, viz: Drs. S. H. Aurand and Sarah Hobson, of Chi- 
cago, W. E. Neiberger, of Bloomington, and J. B. Dunham, of Wenona. 
The first two accepted positions ou the committee and gave very mater- 
ial assistance to the work which the committee accomplished. The 
two latter, Dr. Neiberger and Dr. Dunham, took no active part in the 
committee's work. 

The following resolutions were adopted by the committee at that 
time and as they served as a basis of the committee's work and after 
approval by your executive committee as authority for them are here- 
with indicated in full. 

Whereas, The Illinois Homeopathic Medical Association at its fifty- 
first annual meeting, held in Chicago, May the 8th to the 11th, inclu- 
sive, 1906, unanimously adopted the following resolutions: 

First. That the Illinois Homeopathic Medical Association desires 
that a tuberculosis tent colony shall be established in Illinois under 
homeopathic management. 

Second. That the Illinois Homeopathic Medical Association approves 
of an incorporated society with fully paid up stock. 

Third. That the Illinois Homeopathic Medical Association, and its 
individual members to such an extent as they may be able, agree to 
support such an organization morally, professionally and financially, 
and, 

Whereas, The Illinois Homeopathic Medical Association did, through 
its president, Dr. S. H. Aurand, appoint for the purpose of carrying 
out these resolutions a committee consisting of the following named 
gentlemen: Viz., Dr. Joseph P. Cobb, chairman; Dr. A. E. Smith, 
Dr. Nathan Starr, Dr. O. B. Blackman, Dr. C. T. Hood, Dr. A. L. 
Blackwood, Mr. Mathius Hettinger, Mr. W. E. Prichard, Dr. J. M. 
Downs, ex officio. 

Be it resolved, That this committee, hereafter known as the Tent 
Colony Committee of the Illinois Homeopathic Medical Association, in 
accepting this trust and the work thereby entailed adopt certain rules 
for their government in this work. 

Be it further resolved, That a copy of this preamble and of such rules 
as the committee may hereafter adopt be immediately forwarded to the 
Executive Committee of the Illinois Homeopathic Medical Association 
for their approval, and with the information that the committee will 
not contract any expenses until they shall have been authorized to do 
so by the approval of the rules submitted by them. 

Among others the following rules were adopted for the government 
of the Tubercular Tent Colony Committee during its existence: — 



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356 THE CLINIQUE. 

Rule I. The officers of the committee shall consist of a chairman, 
secretary and treasurer. (The treasurer of the I. H. M. A. shall be, 
and is hereby, designated the treasurer of this committee). 

Rule II. All sub-committee reports shall be presented in writing to 
the Tent Colony Committee at such times as the Tent Colony Com- 
mittee may have designated. 

Rule III. The legitimate expenses of the committee and its sub-com- 
mittees previous to incorporation shall be met by the treasurer of the 
Illinois Homeopathic Medical Association out of the Association's gen- 
eral funds. 

Rule IV. Vouchers to be valid must be certified by the chairman of 
the sub-committees instructed to contract the expense and endorsed by 
the chairman and secretary of the Tent Colony Committee. 

In order that the work of the committee might be carried on more 
systematically sub-committees were appointed covering the different 
lines of work which the committee felt they had to do and the investi- 
gations which they felt called upon to make. The sub-committee on 
Location consisted of Dr. Blackwood, chairman; Dr. Blackman, of 
Dixon; Dr. Downs, of Ottawa; Dr. Hood, of Chicago, and the chairman 
of the general committee. This committee, under the leadership of Dr. 
Blackwood, accomplished most efficient work in the way of investiga- 
tion of the possibilities in the northern part of Illinois. 

The committee adjourned witli the understanding that there should 
be another meeting called in connection with the executive committee 
of the State Association as soon as the sub-committees were prepared 
to make a report. A formal copy of the minutes of this meeting, over 
the signature of the chairman and secretary of the Tubercular Tent 
Colony Committee, was sent to the secretary of the executive, committee 
for its approval. 

On October 24th there was a joint meeting of the Tubercular Tent 
Colony Committee with the executive committee of the Illinois Homeo- 
pathic Medical Association by invitation of the latter. At a formal 
meeting of the executive committee held at this time, the report of the 
previous meeting of the Tubercular Tent Colony Committee with its 
resolutions and requests for instructions were^presented and accepted. 
Immediately following this the Tubercular Tent Colony Committee 
was convened and listened to the reports of its various sub-committees. 
The committee on location made a report through its chairman, Dr. A. 
h. Blackwood, showing that a careful investigation had been made of 
the northern part of Illinois, especially along the Illinois, Fox and 
Rock rivers, with careful consideration of the possibilities offered at 



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THE CLINIQUE. 357 

Ottawa, Dixon, Galena, Freeport and Oregon, as well as locations in 
the immediate vicinity of Chicago; and recommended that a tract of 
land known as the Buffalo Rock farm, situated on the Illinois river, 
three and one-half miles from the town of Ottawa was in their judg- 
ment the most eligible location. This was after there had been a care- 
ful consideration of the questions of transportation, healthy location, 
natural sanitation, abundance of pure water, favorable surroundings for 
recreation, natural slope of land to give the greatest amount of sunshine 
and protection from unfavorable winds. This report of the sub-com- 
mittee was unanimously concurred in by the committee. 

The Committee on Ways and Means made a report through its chair- 
man which substantially re-stated the proposition placed before this 
Association at its last annual meeting, viz: — that a stock company 
should be incorporated under the laws of Illinois. Second, that the 
shares should be offered for sale at par by members of the Tubercular 
Tent Colony Committee. Third, that a first payment of fifty per cent, 
accompany each subscription; that two subsequent payments of twenty- 
five per cent, each should be promised in two and four months respectively 
from date of the subscription. Fourth, that at the time of the annual 
meeting of the Illinois Homeopathic Medical Association in 1907 the 
stockholders should be called together for the purpose of effecting an 
organization. Fifth, that the expense of printing the circular letters, 
other necessary papers, and expenses prior to the time of incorporation 
should be borne by the treasurer of the State Association. The report 
of this sub-committee was also approved by the general committee. 

The committee appointed Dr. James N. Downs, president of the State 
Association, as its business agent with instructions to secure the most 
favorable option on the Buffalo Rock farm which it was possible to do 
for the committee. 

On November 8th the committee met in joint session with the Exe- 
cutive Committee of the State Association. At which time the minutes 
of the previous meeting of the Tubercular Tent Colony Committee were 
formally presented to the Executive Committee of the State Association, 
and by them approved. Dr. Downs, as business agent, made a report 
showing that he had entered into a contract for the purpose of the Buf- 
falo Rock farm under the following terms: That four hundred dollars 
contract money should be paid down at the time of the signing of the 
contract; six hundred dollars more in thirty days, making one thous- 
dollars; the balance sixty days later. This contract was approved by 
the committee, and the chairman of the committee was instructed to 
take the necessary steps to close the same. 



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358 THE CLINIQUE. 

The committee further appointed a business committee in order to 
avoid the necessity and expense of further meetings of the general com- 
mittee. This special committee consisted of the chairman, Dr. Aurand 
and Dr. Blackwood, who from this time on assumed the responsibility 
of looking after the work of the business agent of the committee and of 
the presentation of the proposition to the profession of the state. 

For that committee I wish to report that a letter giving a complete 
statement of what the committee had done and of the natural possibil- 
ities of the site selected was prepared and printed in the November issue 
of The Clinique, the official organ of this association. Furthermore, 
a copy of the same was sent by mail to each member of the profession 
in Illinois. The response to this letter was very meagre. A second 
letter was published in the December Clinique, urging the necessity 
for immediate action if the contract entered into by your committee 
was to be honored. The committee was indefatigable in its personal 
efforts in presenting the matter to the different members of the profes- 
sion. The chairman himself presented the matter by personal letter to 
at least fifty physicians in the state, and verbally to as many more in 
the city. Other members of the committee took equally active efforts 
to enlist the support of the profession. When it became apparent that 
the profession were not going to take sufficient interest in the matter 
to avail themselves of the contract which had been made, and it was 
evident that the thousand dollars which had been paid by the Execu- 
tive Committee as a first payment under the contract would be lost by 
inability on the part of the Tubercular Tent Committee to meet future 
payments on the contract, steps were taken to make this sacrifice un- 
necessary, and four members of the committee personally assumed the 
responsibility of putting the project through, at least to the extent of 
purchasing the land and paying back into the treasury of the State 
Association the money loaned for the purchase of the same. 

It gives me pleasure to report that your treasurer has been reim- 
bursed and that in spite of the apathy of the individual members of the 
profession the Association has not incurred any loss. A statement of 
the status of affairs was made in the January Clinique over the signa- 
ture of the members who had assumed the contract. 

The Tubercular Tent Colony Committee's work as a committee was 
completed when the contract which they had obtained was taken off 
their hands, and while the committee feels considerable chagrin that 
the enthusiasm displayed at your annual meeting did not live for even 
one year, yet they feel that they are entitled to your approval for hav- 
ing put through the plan which had slumbered in the minds of the 



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THE CLINIQUE. 359 

previous committee for one year; that they succeeded in finding a suit- 
able location; that they organized a plan which made it possible to pur- 
chase the land; and that as a result of their efforts sufficient enthusiasm 
was stirred up in the minds of a few to relieve the committee of what 
might have served as a serious loss to the State Association. 

Bear in mind that the Tubercular Tent Colony Committee were act- 
ing under your instructions to organize and incorporate a company for 
the carrying on of. a tubercular colony. That furthermore they re- 
ported to your executive committee each step of their progress before 
its consummation. Your executive committee probably, like this 
special committee, had in mind the fervid oratory at your last annual 
meeting when the Association very earnestly and unanimously stated 
that they desired to have a company incorporated and believed that the 
necessary funds for the organization would be supplied by the profes- 
sion and their friends; and, therefore, would not have been entitled to 
your censure even if the thousand dollar contract money which they 
authorized the Tubercular Tent Colony Committee to make had not 
been covered back into your treasury. 

Personally, as chairman of the committee, I desire to express my 
appreciation of the very efficient work which has been done by different 
members of this committee, and especially by the members of the Sub- 
committee on Location, of which Dr. Blackwood was chairman. 
Furthermore, the committee desires me to express its appreciation of 
the very cordial support which was given to the Tubercular Tent Colony 
Committee by the Executive Committee as a committee. 

The following expense account has been charged up to this commit- 
tee after having been O. K'd. by the chairman and secretary of the 
committee. Expenses for meetings of the committee and traveling 
expenses of the individual members in attendance at the meetings and 
in the purpose of investigating the different localities for the proposed 
sites, which have been paid by your treasurer amounts to $143.91. 

Respectfully submitted, 

For the T. Tent Colony Com. 

Jos. P. Cobb, Chairman. 
A. E. Smith, Sec'y- 

REPORT FROM THE ORGANIZATION COMMITTEE. 

Madam President, Officers and Members of the Illinois Homeopathic 
Medical Association: 

Your committee on organization, through its chairman, has the pleas- 
ure and honor to submit the following report: While we can report pro- 



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360 THE CLINIQUE. 

gress in this important work yet much of that which has been done dur- 
ing the year will not at present materialize in complete results. We 
believe however that in the near future we will be able to realize more 
fully the value of the work which has been started during this year. 

Three articles on organization work, have been written by members 
of the committee and published in our official journal, The Cunique, 
during the year. These articles appeared in the July, November and 
January issues of The Cunique. The object of these articles was to 
impress duty, stir up enthusiasm, show inducements and to set forth 
plans, in the organization work. 

We held two meetings during the year, one in the month of October 
and the other in November. There were present at our first meeting 
Drs. Hanks, George, Sweet, Denman, Blackman, Delamater, Tenney 
and Aurand. At this meeting methods and plans were discussed 
whereby we might successfully carry on the work. Dr. O. B. Black- 
man of Dixon was appointed a committee of one to divide the state in- 
to practical working districts and to classify the names of the homeo- 
pathic physicians in the various districts so that we might have a 
feasible basis from which to proceed. Dr. A. C. Tenney of Chicago 
was appointed a committee of one to draft an article (which was refer- 
red to above) for publication in The Cunique. 

Our second meeting was held in the month of November, at the Union 
Hotel in the City of Chicago. The following members were present: — 
Drs. Hanks, George, Sweet, Denman, Blackman, Delamater, Tenney, 
Wieland, and Aurand. There were present also at both of our meet- 
ings a number of the good workers of The Tubercular Tent Colony 
Committee, whose meeting immediately followed ours. . They gave us 
much encouragement and good suggestions. At this meeting Dr. Ten- 
ney reported progress on the article which he was appointed to write. 
Dr. Blackman presented the following report and recommended that 
the State be divided into districts as follows: — There are eight local 
homeopathic societies already organized — 

First. The Rock River Institute of Homeopathy which should com- 
prise the counties of DaKalb, Ogle, Lee, Carroll, and Whiteside. They 
are represented by 49 homeopathic physicians. 

Second. Northwestern Homeopathic Medical Society, which in- 
cludes Jo Da vies, Stephenson, Winnebago, and Boon counties. These 
counties are represented by 30 homeopathic physicians. 

Third. Eastern Illinois Homeopathic Society, which should take in 
the following counties: Edgar, Douglas, Moultrie, Coles, Chaplain, and 
Clark. These counties are represented by 39 homeopathic physicians. 



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THE CUNIQUE. 361 

Fourth, Fifth and Sixth. The Chicago Homeopathic Medical Society , 
The Englewood Homeopathic Medical Society, and The Clinical Soci- 
ety of Hahnemann College, all in Cook county, and represent between 
five and six hundred homeopathic physicians. 

Seventh. The Central Illinois Homeopathic Society, which includes 
the following counties: Mclean, Woodford, Tazwell, Peoria, Stark, 
and Fulton. These counties are represented by 50 homeopathic 
physicians. 

Eighth. The Mississippi Valley Homeopathic Medical Society. 
This, as I understand it, is The Rock Island Homeopathic Medical 
Society and is made up from the following counties: Rock Island, 
Mercer and Henry, and is represented by 33 homeopathic physicians. 

The following groups of counties are unorganized. According to Dr. 
Blackman's map which he presented in his report, we should succeed 
in organizing twelve new homeopathic societies in the state of Illinois 
in the next two years. 

First. The counties of McHenry, Lake, Kane, Dupage and Kendal, 
contain 58 homeopathic physicians and should support a rousing good 
society. 

Second. Will, Grundy, Kankakee and Livingston counties contain 
37 homeopathic physicians and should support an organization. 

Third. Iroquois, Ford, Vermillion and Champaign counties have 28 
homeopathic physicians and should be organized. 

Fourth. Hancock, Brown, Adams, McDonough and Schuyler coun- 
ties have 23 homeopaths and could support an organization. 

Fifth. Mason, Cass, Menard, Scott, Morgan, Sangamon, Christian, 
and Pike counties have 34 homeopathic physicians and could do them- 
selves and homeopathy much good by organizing. 

Sixth. Logan, Dewitt, Macon, and Piatt have 22 homeopaths and 
should organize. 

Seventh. Knox, Warren, and Henderson counties have 14 homeo- 
paths and could make quite a stir in the homeopathic ranks if they 
would organize. 

Eighth. Bureau, Putnam, and LaSalle counties have 21 homeopaths 
and should keep pace with times by organizing. 

Ninth. Madison, Bond, Clinton, St. Clair, Monroe and Randolph 
counties have 18 homeopathic physicians and should come into the 
ranks of the organizations. 

Tenth. Washington, Marion, Jefferson, Cary and Wayne counties 
have 8 homeopaths and if they are wide awake they should unite them- 
selves into an organization. 



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362 THE CLINIQUE. 

Eleventh. Shelby, Fayette, Effingham, Jasper and Crawford counties 
have six homeopathic physicians and they too could make a better 
showing if they would organize themselves into a society than they can 
otherwise. 

The organization committee recommends that there be no let up in 
this very important work until every one of these groups of counties 
are brought into the fold and all of these splendid homeopathic physi- 
cians are getting all that is their due and are giving all that they should 
to the support of their system of medicine. 

Early in the year before we adopted the plan of definitely dividing 
the state into districts, I attempted to organize the physicians of the 
Peoria-Galesburg district. I wrote nine letters to nine physicians and 
received two replies. One was from an enthusiastic homeopath who 
heartily favored the move and the other was from an eclectic who did 
not object. 

Now since we have definite basis from which to work it has been our 
plan to give each member of the committee definite work to do. We 
have only begun to deal out to individual members of the committee a 
definite group of counties which this individual member is expected to 
work up and to organize. 

Dr. A. C. Tenney has taken charge of the group of counties com- 
posed of McHenry, Lake, Kane, Dupage, and Kendal. In these coun- 
ties there are in the neighborhood of 58 homeopathic physicians. 
Dr. Tenney has written to each of these physicians, in all 58 letters. 
He received eight replies and two of these were not in favor of organiz- 
ing a society, six expressed themselves as favorable, with a varying de- 
gree of enthusiasm. Dr. Tenney wrote a second letter to these six, 
who showed loyalty to homeopathy, and arranged for a meeting here 
sometime during the continuance of this convention. I predict that 
the disinterested physicians in this district will eventually become in- 
terested and that Dr. Tenney will succeed in organizing a rousing good 
society in this district in the near future. 

Dr. O. B. Blackman, of Dixon, was given charge of the following 
group of counties: Mason, Cass, Menard, Scott, Morgan, Sangamon, 
Christian, and Pike. These counties are represented by 34 home- 
opathic physicians, and we believe Dr. Blackman will succeed in organ- 
izing a good, healthy society here. Thus you can see that the work 
has been properly begun, and if prosecuted with energy will soon result 
in many new organizations and much added strength to homeopathy. 

The local societies which are already organized have not been forgot- 
ten. A number of the leading physicians of Chicago have written pa- 



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THE CLINIQUE. 363 

pers for and attended these societies during the year. Splendid enter- 
tainment and a profitable time has been reported in each instance. 
Those whose names have been reported to me are Drs. Collins, Delama- 
ter, Wood, Blouke, Kahlke, Vaughan, Halbert and Haseltine. 

Last but not least by any means, we have the pleasure to report the 
organization of one new society. The physicians of Oak Park, Austin 
and surrounding community have succeeded in organizing a very prom- 
ising society. On Thursday evening, May 2nd, Drs. Tenney, McBean 
and Aurand were invited out to assist in the delivery of this healthy and 
full-term infant. This child has been christened, " The Western 
Branch of the Chicago Homeopathic Medical Society." Dr. Tenney 
with his ministerial sanctity performed the ceremony. 

Early in the evening the doctors began congregating in the office of 
Drs. McBurney and Ruggles until those beautifully furnished apart- 
ments were filled. 

After listening to several speeches by the visiting brethren we were 
informed that we must immediately betake ourselves to the banquet hall 
where we found a well-loaded table in waiting. The doctors of our 
western suberbs know how to entertain I'll assure you. Here we ate 
and organized until we we were all full and happy. Dr. B. A. McBurney 
was elected president. Dr. W. L. Ruggles, vice-president: Dr. C. A. 
Hendy, Secretary-treasurer. The above officials will constitute a board 
of trustees. The following were elected on the board of censors. Dr. 
L. W. Beebe, C. S. Brewer and J. Bieger. The membership starts 
out with a membership of fifteen and will hold its meetings monthly. 
We are proud of this new addition to our organizations and can promise 
you that you will frequently hear of this wideawake, u Western Branch 
of the Chicago Homeopathic Medical Society." 

We believe that upon our ability to organize depends the life and 
usefullness of homeopathy, therefore we would implore every wide- 
awake and loyal homeopathic physician to become interested in this 
important work. 

All of which is respectfully submitted, 

S. H. Aurand, Chairman. 

necrologist's report. 

Dr. H. H. Chase, of Rock Island, 111., died very suddenly on the 
22d day of May, 1906. He graduated from the Chicago Medical Col- 
lege in 1881, was a member of the Illinois Homeopathic Medical Asso- 
ciation, and ex-president of the Rock Island Homeopathic Medical So- 
ciety, also a member of the Rock River Institute of Homeopathy. Dr. 



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364 THE CUNIQUE. 

Chase was a son of Dr. H. A. Chase, of Amboy, 111., who was one of 
our earliest and most substantial homeopathic physicians. Dr. H. H. 
Chase died of blood poisoning. 

Dr. M. M. Thompson, of Chicago, aged 61 years, was struck and 
fatally injured by a passenger train last March. Dr. Thompson came 
to Chicago in 1875. For ten years prior to this he was a Congrega- 
tional minister in Iowa, but was compelled to retire from the ministry 
on account of the loss of his voice. He graduated from the Chicago 
Homeopathic College in 1886, and the following year he located in 
Austin. He was for some time professor of surgery in the Hering 
Medical College, was a member of the American Institute and the In- 
ternational Homeopathic Association and the Chicago Pathological So- 
ciety. 

Dr. R. P. Wales, formerly of Mt. Carroll, 111., some time since was 
compelled to move to Colorado Springs, Colo., on account of failing 
health, where he died. Dr. Wales in the early days of homeopathy in 
Illinois, was widely known as a very successful homeopathic physician 
and enjoyed a very extensive practice in northern Illinois. Drs. R. P. 
and Henry W. Wales, now of Lanark, were consulted far and near in 
the early history of homeopathy in the northern part of this state by 
people who preferred this school of practice. 

Dr. E. M. P. Ludlam died in Chicago, Saturday Feb. 9, 1907. Dr. 
Ludlam was a brother of the former Nestor of Homeopathy, Professor 
R. Ludlam, of Hahnemann College. 

REPORT OF THE COMMITTEE ON THE PRESIDENT'S ADDRESS. 

We take great pleasure in commending the address as a whole. It is 
a worthy production and should be highly appreciated for its advanced 
thought and public spirit. 

First. We admire and appreciate Dr. Hanks' logical reasoning 
which led up to the important climax of " Toleration and Generosity 
in Judgment. " With her we recommend that petty factional differences 
be laid aside and forgotten and that we as a profession devote our time 
and energies to more important issues upon which we can universally 
agree. 

Second. We fully agree with our president and heartily commend 
her views regarding the necessity for more complete organization. We 
believe in the truthfulness of her statement that u The main reason that 
we lack influence with legislative and corporate bodies is due to our 
want of strength" and we add that our own weakness — as a body — is 
due to our lack of complete organization. 



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THE CLINIQUE. 365 

Third. We greatly appreciate the kind and truthful statements 
made by Dr. Hanks about the Tuberculosis Tent Colony Committee. 

Fourth. The thoughts on the establishment of reciprocity between 
the different States of the Union are heartily commended. We also 
concur with our president's views regarding pharmaceutical ethics, that 
the ethical pharmacists should be recognized and patronized by the 
profession. 

Fifth. We agree, that it is the urgent duty of the profession to place 
our Materia Medica upon a faultless foundation and would recommend 
that our State Association assist as much as practicable in this important 
work. 

Sixth. We believe that for the welfare of homeopathy, for the great- 
est harmony and for the best interests of the profession each state 
should control and maintain its own distinctive organization. So far 
as reciprocity and friendly co-operation between organizations of differ- 
ent states is concerned that is heartily commended but in order to main- 
tain the integrity and identity of our State Association official member- 
ship must be limited to resident members. 

Seventh. We approve the suggestion that press reports be edited by 
a medical man. 

Eighth. We heartily commend the principles of loyalty to our in- 
stitutions and to each other. 

Ninth. We recommend that 500 reprints be furnished for Dr. Hanks 
to distribute among her friends. 

{S. H. Aurand, 
S. M. Hobson, 
F. K. Hili.. 



MINNESOTA STATE HOMEOPATHIC INSTITUTE. 

PRESIDENT'S ADDRESS — REGINALD B. LEACH, M. D., MINNEAPOLIS, 

MINN.* 

Officers and Members of the Minnesota State Homeopathic Institute, 

Ladies and Gentlemen: 

As the by-laws of this society decree that your presiding officer shall 
deliver an address at this period of each annual session and as it pre- 
supposes that the speaker will present a subject (or subjects) of special 
interest to the members and of probable import to the cause of Similia, 

•Delivered at the annual meeting of the Minnesota State Homeopathic Institute, 
May 21, 1907. 



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366 THE CLINIQUE. 

and, as I believe mine the most important subject for each member of 
this institute to carefully consider and personally decide today, I have 
the honor to herewith comply with our laws to the very best of my 
ability. 

I hasten to precede the discussion of my theme, however, with the 
assurance that, in my judgment, this meeting could not have been the 
success it certainly has been, excepting for the untiring devotion of 
our worthy secretary, together with the able assistance of our Bureaux 
chairmen, and the committee of arrangements, and the loyal support 
of the members; to all of whom I am under special obligation, and to 
whom I desire at this time to express my grateful acknowledgments. 

As the universe is governed by immutable laws, and, as the Law of 
Similars is in my opinion, one of said laws, the contemplation of this 
law as it applies to my subject, brings me face to face, as it were, with 
a realization of my own shortcomings, and of the great responsibility, 
as well as honor, that goes with the presidency of such an association 
as is ours, together with an earnest desire and intent to make no mis- 
take; to utter nothing ambiguous. 

As one who knew has put it: " To perfect what we have received, 
and to honor Hahnemann by carrying out the good work begun by 
him — work that no one man, no one life-time could finish — to assimi- 
late all that is logical and practical, from whatever source it may spring, 
is the duty of the members of this and of all similar societies." 

Virgil says: 

"The ghosts rejected are the unhappy crew 
Deprived of sepulchres and funeral due." 

Like one of these, my subject, " The Amalgamation of the Schools," 
is still before us; is kept there by others, not by us; and, as I believe 
its burial timely, I most respectfully beg leave to herewith add my mite 
toward this very much desired ceremony. 

In approaching my topic I wish to declare, in unmistakable terms, 
my belief that this so-called " amalgamation," this ideal conferrumina- 
tion, under present conditions, is a misnomer, nothing else; and that 
it would be nothing less than professional suicide for those of our school 
who might be so banefully influenced as to accede to the importunate 
solicitations of our confreres of the so-called " regulars," and accept the 
narrow margin of self-respect left them after taking such a leap into the 
dark. 

For, while I in no way intend to arraign, or desire this address to be 
construed as sat arraingment of, the motives of any particular member 



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THE CLINIQUE. 367 

of the " Old School,' ' I do intend to arraign, and trust that this will be 
understood as an arraignment of, the nature and consequences of the 
past and present attitude of that school as a supposedly collaborative 
" school" of the healing art. And while I unhesitatingly applaud 
every honest effort and achievement among the members of any school, 
the willingness to be lost sight of, by and in> the dominant school, is 
not in my make-up. The question is one, however, for every home- 
opathist to consider and decide for himself; one that should be met 
more than half way by each, fearlessly and without equivocation, with 
all fancies eliminated with all facts in plain view. 

Under present, one-sided restrictions of the " old school," amalgama- 
tion* is an absurdity, an impossibility, and cannot obtain; and the 
sooner homeopathists present a united opposition to those requesting 
us to " affiliate" with them, or (note the or), until that " school" 
adopts the homeopathic materia medica and therapecutics as promul- 
gated by Hahnemann and proved by Hahnemann and his co-adjutors ; 
until these special branches* of the healing art are made an integral 
part of the curriculum in all of their colleges ; until all students are 
required to pass rigid examinations in our materia medica and therapeu- 
tics, as well as in the materia medica and therapeutics of the "old 
school "; until these studies are presented all students by men of large 
practical experience in the application of same ; until these studies 
are practically demonstrated in the clinics to all students in all "old 
school " colleges, it is far better that we retain and maintain separate 
institutions of learning ; separate city, county, state and national 
organizations ; in fact, better that we preserve the dignified isolation 
forced upon Hahnemann and his co-workers. For while it is wise (as 
Emerson says) to "teach that each generation begins the woild 
afresh in perfect freedom, unhampered and unbound by the thought or 
tradition of the dead past, but free to choose and utilize from recorded 
human experience aught that will conduce to its progress," it is an in- 
con trovertable fact that "the homeopathic prescription, when indicated, 
fills the bill today and will so continue for all time to come, just as it 
ever has since first enunciated by Hahnemann ; that we who have tried 
it, know this to be a veritable truism ; that he who has not tried it, is 
to be pitied. As sincere investigators into the cause, prevention and 
cure of disease, " we should at all times be willing to cast aside theo- 
ries which time and experience have proved untenable, and supplant 
them by others that seem more logical and better conform to modern 
thought and attested fact." With this before us, what theory, may I 
ask, enunciated by Hahnemann, adopted and practically proved by us, 



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368 THE CLINIQUE. 

has u proved untenable?" What idea, admonition or prediction of 
Hahnemann does not " conform to modern thought and attested fact ?" 
Is it the " Germ Theory " of Koch, wherein he demonstrated, in 1883, 
the contagiousness of Asiatic cholera, through the comma bacillus, as 
predicted by Hahnemann fifty-two years before? In 1831 (in Leipsic) 
Hahnemann wrote : " The most striking examples of infection and 
rapid spread of cholera take place, as is well known, and as public 
journals likewise inform us, in this way: On board ships, in those 
confined spaces, filled with mouldy, watery vapours, the cholera miasm 
finds a favorable element for its multiplication, and grows into an 
enormously increased brood of those excessively minute, living crea- 
tures, so inimical to human life, of which the contagious matter of 
cholera most probably consists." 

Is it the " vaccination theory" of Jenner, today almost universally 
adopted as the protective, par excellence r against smallpox? In 1833, 
in chapter 46 of his Organon, Hahnemann said: "It is well known 
that, when variola is added to cowpox, the 'former, by virtue of its su- 
perior intensity, as well as its great similitude, will at once extinguish 
the latter homeopathically, and arrest its development. Cowpox, on 
the other hand, having nearly attained its period of perfection will, by 
its similitude, lessen, to a great extent, the virulence and subsequent 
eruption of smallpox. ' ' Is there anyone, who has had any considerable 
experience with smallpox and vaccination, who will pretend to suc- 
cessfully controvert this statement? Does Hahnemann's assertion that 
vaccination "will at once extinguish the latter, i. e., the smallpox, 
homeopathically," fail to explain? Are there not some recent admis- 
sions, by "old school authorities," as to the verity of Hahnemann's 
asseverations ? In August of 1906, Von Behring, of Antitoxin fame, 
publicly admitted that "In spite of all scientific speculations and ex- 
periments regarding smallpox vaccination, Jenner 's discovery remained 
an erratic block in medicine till the biochemically-thinking Pasteur, 
devoid of all class-room knowledge, traced the origin of this therapeu- 
tic block to a principle which cannot better be characterized than by 
Hahnemann's word " homeopathic." 

Is it the "tuberculin theory" of Koch, against tuberculosis? Is 
this another reminder of the chaos in " regular" medicine in Hahne- 
mann's time, or just one more example of how the first allopathist of 
the 19th Century to gain any repute was made famous by his adoption 
of the Law of Similars, and circumlocution in practically demonstrating 
the efficiency of said law without admitting the one and only source of 
his working hypothesis? A living example, forsooth, of the cryptic 



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THE CLINIQUE. 369 

response of Ex-Governor Pennypacker, of Pennsylvania, who, when 
asked to explain his part in a certain transaction, replied: " Celerity 
should be contempered with cunctation." Am I not correct? Listen: 
With homeopathy under the ban, and Hahnemann's great humanitar- 
ianism almost lost sight of today, Robert Koch basks in the radiance of 
admitted greatness. And, for what ? For # practically proving, with 
the aid of a microscope (which Hahnemann did not have) the presence 
of, and giving a name to, " those excessively minute, invisible, living 
creatures " (predicted by Hahnemann) found in all cases of unquestion- 
able cholera Asiatica. For having put Hahnemann's theory of similia 
to practical use, in what is known as " Koch's Tuberculin," of which 
Dr. Cabot last November said: "The use of Tuberculin is a form of 
vaccination which illustrates better than any example known to me the 
approval of homeopathic principles in our school." " Surely," he con- 
tinues, " this is a case of similia similibus curantur," as homeopathic 
writers have pointed out. Why, then, this honoring of Koch, the 19th 
Century prover of his theories, by a class who denied our right, and for 
ten years pertinaciously opposed our placing in the capitol of our coun- 
try, the bronze and granite memorial we eventually unveiled in that 
city to the greatness of Hahnemann; the originator of more theories 
that, tested, have " made good," than any other man in all medical 
history. 

(Vide: "The Wine Test," "The Law of Similars," "The Infini- 
tesimal Dose," "The Single Remedy," "The Germ Theory of Con- 
tagion," "Soluble Mercury," "Belladonna Prophylaxis of Scarlet 
Fever," "Drug Provings on Human Beings," etc.) 

Or is it the "Anti-toxin" of Behring that has proved the Law of 
Similars fallible, and that homeopathy does not " conform to modern 
thought and attested fact." Listen: After referring to the practice of 
vaccination against smallpox as being " homeopathic, " von Behring, 
in 1906, continued: "Indeed, what else causes the epidemiological 
immunity in sheep, vaccinated against anthrax, than the influence pre- 
viously exerted by the virus, similar in character to that of the fatal 
anthrax. And by what technical term could we more appropriately 
speak of this influence, exerted by a similar virus, than by Hahne- 
mann's word Homeopathic. 

Is it that we, the so-called " irregulars," whose remedies are to this 
day designated in their books as "un-official " fear to longer " flaunt 
the red rag," the infinitesimal dose, before the allopathic "bull;" or 
that we now desire to "hide under a bushel " the therapeutic light of 
our attenuations as advocated by Hahnemann in 1810, and until very 



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370 TH